Provider Demographics
NPI:1063850154
Name:SHANNON, DAISHA RENES (BA)
Entity Type:Individual
Prefix:MS
First Name:DAISHA
Middle Name:RENES
Last Name:SHANNON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 N CLASSEN BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6835
Mailing Address - Country:US
Mailing Address - Phone:405-605-2292
Mailing Address - Fax:405-605-2266
Practice Address - Street 1:1330 N CLASSEN BLVD STE 20
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6835
Practice Address - Country:US
Practice Address - Phone:405-605-2292
Practice Address - Fax:405-605-2266
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst