Provider Demographics
NPI:1053936799
Name:ZULLO, SHANNON WATSON (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:WATSON
Last Name:ZULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:RENEE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 MASON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4617
Mailing Address - Country:US
Mailing Address - Phone:984-974-4462
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR # 7600
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-7834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine