Provider Demographics
NPI:1083140776
Name:WEYNAND, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WEYNAND
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 1:870 GOLD HILL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8988
Mailing Address - Country:US
Mailing Address - Phone:803-620-8250
Mailing Address - Fax:803-638-6901
Practice Address - Street 1:870 GOLD HILL RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8988
Practice Address - Country:US
Practice Address - Phone:803-620-8250
Practice Address - Fax:803-638-6901
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008340235Z00000X
NC13202235Z00000X
SC7460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist