Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Shannon Mentock, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1104353796

Dr. Shannon Mentock, MD is a Family Practice in Petaluma, California. Graduated from Wake Forest University School of Medicine in 2017, 9 years ago. Practices with Petaluma Health Center Inc, a 76-clinician group and accepts Medicare assignment. Licensed in California and Colorado.

Years since qualifying
9
Trained at
Wake Forest University School of Medicine
Licensed in
CA, CO
In the registry since
2017
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1179 N McDowell Blvd
Petaluma, CA 94954-6559
Phone: (707) 559-7500
Fax: (707) 559-7620
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 174978 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (CO)
Family Medicine Physician Taxonomy 207Q00000X · Licence DR.0063003 (CO)

Record details

NPI number1104353796
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 15, 2017
Last updated in NPPESMarch 21, 2022
Certification dateMarch 21, 2022
Mailing address1179 N McDowell Blvd, Petaluma, CA 94954-6559

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolWAKE FOREST UNIVERSITY SCHOOL OF MEDICINE
Graduated 2017 (9 years in practice)
Group practice Petaluma Health Center Inc — 76 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Petaluma