Provider Demographics
NPI:1255503801
Name:SHANNON, DOROTHY A, (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:A,
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9936 WHITWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5641
Mailing Address - Country:US
Mailing Address - Phone:410-461-0887
Mailing Address - Fax:
Practice Address - Street 1:9936 WHITWORTH WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5641
Practice Address - Country:US
Practice Address - Phone:410-461-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD018231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist