NPIMap

Individual provider Active NPI

Shannon Zullo, MD

  • Dermatology Physician
  • Allentown, PA
National Provider Identifier
1053936799
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD491482 Issued in PA
Practice address
3151 Walbert Ave Ste 301
Allentown, PA 18104-6630
Phone
(484) 503-7546
NPI assigned
Jun 9, 2020
Last updated
Sep 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD491482 PA Primary

Addresses

Primary practice location

3151 Walbert Ave Ste 301
Allentown, PA 18104-6630

Mailing address

3151 Walbert Ave Ste 301
Allentown, PA 18104-6630
Phone (484) 503-7546

Other names 1

  • Ms. Shannon Renee Watson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251008000848 PA Practitioner - Dermatology 4183046741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Arizona College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

1600 St Lukes Blvd
Easton, PA 18045-5671

1872 St Lukes Blvd
Easton, PA 18045-5669
Phone (484) 526-7800

3151 Walbert Ave
Allentown, PA 18104-6042

5415 Lanark Rd
Center Valley, PA 18034-8693
Phone (484) 526-1260

5425 Lanark Rd
Suite 300
Center Valley, PA 18034-8693
Phone (484) 523-7300

801 Ostrm St
Bethlehem, PA 18015-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of skin cancer186
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Physician Group, Inc. CurrentSince Oct 6, 2025 Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St Luke's Physician Group Inc CurrentSince Oct 6, 2025 Accepting new patients

Locations

3151 Walbert Ave
Ste 301
Allentown, PA 18104
Phone (484) 526-1260

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Interoperability endpoints

  • Direct secure messaging: szullo360413@direct-sluhn.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1053936799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 WALBERT AVE STE 301",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181046630",
            "telephone_number": "484-503-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3151 WALBERT AVE STE 301",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181046630",
            "telephone_number": "484-503-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZULLO",
        "first_name": "SHANNON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD491482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "WATSON",
            "middle_name": "RENEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.