Provider Demographics
NPI:1073387882
Name:WELLS, SHANNON T
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:T
Last Name:WELLS
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 1:3731 RUE MICHELLE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-7223
Mailing Address - Country:US
Mailing Address - Phone:504-376-3410
Mailing Address - Fax:
Practice Address - Street 1:3731 RUE MICHELLE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7223
Practice Address - Country:US
Practice Address - Phone:504-376-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator