Provider Demographics
NPI:1134503980
Name:ATENCIO, SHANNON MONIQUE
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MONIQUE
Last Name:ATENCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MONIQUE
Other - Last Name:CRESPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8011 HARPER DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1054
Mailing Address - Country:US
Mailing Address - Phone:505-858-3134
Mailing Address - Fax:
Practice Address - Street 1:8011 HARPER DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1054
Practice Address - Country:US
Practice Address - Phone:505-858-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist