Provider Demographics
NPI:1114625340
Name:MILES, SHANNON (NRCMA, NRCPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:NRCMA, NRCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 WALTERS RD STE 807
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1567
Mailing Address - Country:US
Mailing Address - Phone:346-317-1192
Mailing Address - Fax:346-223-1888
Practice Address - Street 1:14405 WALTERS RD STE 807
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1567
Practice Address - Country:US
Practice Address - Phone:346-317-1192
Practice Address - Fax:346-223-1888
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy