Provider Demographics
NPI:1043980279
Name:SHANNON, PARISH JORDAN
Entity Type:Individual
Prefix:
First Name:PARISH
Middle Name:JORDAN
Last Name:SHANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S DIXIE DR APT B
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2141
Mailing Address - Country:US
Mailing Address - Phone:937-979-0284
Mailing Address - Fax:
Practice Address - Street 1:109 S DIXIE DR APT B
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2141
Practice Address - Country:US
Practice Address - Phone:937-979-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide