Provider Demographics
NPI:1043408297
Name:GALES, SHANNON YVETTE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:YVETTE
Last Name:GALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MAIN ST
Mailing Address - Street 2:#830
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4327
Mailing Address - Country:US
Mailing Address - Phone:214-893-4882
Mailing Address - Fax:866-544-3308
Practice Address - Street 1:2201 MAIN ST
Practice Address - Street 2:#830
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4327
Practice Address - Country:US
Practice Address - Phone:214-893-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSHANNON GALES175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath