Provider Demographics
NPI:1114042785
Name:ALMBERG, SHANNON CLINITE (OTR)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CLINITE
Last Name:ALMBERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 BODINE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-1745
Mailing Address - Country:US
Mailing Address - Phone:757-717-3754
Mailing Address - Fax:757-819-7709
Practice Address - Street 1:1502 BODINE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-1745
Practice Address - Country:US
Practice Address - Phone:757-717-3754
Practice Address - Fax:757-819-7709
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist