Shannon Easton-Carr, MD, Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A111411 Issued in CA

Legal business name

SHANNON EASTON-CARR, MD, INC

Practice address

2102 Edsel Ave
Modesto, CA 95350-2819

Phone

(805) 762-4739

Fax

(888) 462-8045

NPI assigned

Feb 27, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Shannon Easton-Carr, MDNPI 1508091711

Title

President

Phone

(805) 762-4739

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Easton-Carr, MD

  • Psychiatry Physician
  • Modesto, CA
  • NPI 1508091711
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1424995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1821480864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 JOHNSON AVE",
            "address_2": "BOX 313",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013306",
            "telephone_number": "805-762-4739",
            "fax_number": "888-462-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 EDSEL AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953502819",
            "telephone_number": "805-762-4739",
            "fax_number": "888-462-8045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1428 Phillips Ln Ste 202",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "934012567",
            "country_code": "US",
            "telephone_number": "805-762-4739",
            "fax_number": "805-462-8045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHANNON EASTON-CARR, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-27",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "EASTON-CARR",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-762-4739",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A111411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bilal Shaikh
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• Simon Shamass, MD
• Prithvi Nambalat Shankar, MD
• Arpana Shanker, BCBA
• Vivig Shantha Kumar, MBBS
• Zahra Sharifi
• Ashleen Sharma
• Kriti Sharma, M.D.
• Nikhil Sharma, DO

• Psychiatry Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.