Basic Information
| Provider Information | |||||||||
| NPI: | 1023005303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMBONI | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 RALSTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757861110 | ||||||||
| FaxNumber: | 7757888075 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 RALSTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757861110 | ||||||||
| FaxNumber: | 7757888075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9022 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.