Provider Demographics
NPI:1093572885
Name:LEGATE, SHANNON LEE (BS, RRT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:LEGATE
Suffix:
Gender:F
Credentials:BS, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 SILVERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5128
Mailing Address - Country:US
Mailing Address - Phone:501-258-2788
Mailing Address - Fax:
Practice Address - Street 1:606 SILVERWOOD TRL
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-5128
Practice Address - Country:US
Practice Address - Phone:501-258-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0789227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered