Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shannon Rae Sgro, PA-C

Individual provider Medical Physician Assistant · NPI 1396790358

Shannon Rae Sgro, PA-C is a Physician Assistant in Roseville, California. Qualified in 2000, 26 years ago. Practices with Integrated Dermatology of Roseville PC, a 6-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
26
Licensed in
CA
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1412 Blue Oaks Blvd
Roseville, CA 95747-7143
Phone: (916) 784-7546
Fax: (916) 784-7548
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 15649 (CA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA15649 (CA)

Record details

NPI number1396790358
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 24, 2006
Last updated in NPPESAugust 5, 2026
Certification dateAugust 5, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2000 (26 years in practice)
Group practice Integrated Dermatology Of Roseville Pc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Roseville