Provider Demographics
NPI:1245244938
Name:DANNENFELSER, SHANNON (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:DANNENFELSER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:8114 SANDPIPER CIR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4934
Mailing Address - Country:US
Mailing Address - Phone:410-933-8459
Mailing Address - Fax:410-933-8712
Practice Address - Street 1:8114 SANDPIPER CIR
Practice Address - Street 2:SUITE 114
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4934
Practice Address - Country:US
Practice Address - Phone:410-933-8459
Practice Address - Fax:410-933-8712
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245244938OtherCHAMPUST
11779850OtherCAQH
5070-0047OtherCAREFIRST
3503195000OtherAMERIHEALTH
88760514OtherNCA
3503195000OtherIBC AMERIHEALTH
5070-0047OtherCAREFIRST
MD216512Medicare ID - Type Unspecified