Provider Demographics
NPI:1275058182
Name:SCEARCE, SHANNON
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:SCEARCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 REEAND LN
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21623-1449
Mailing Address - Country:US
Mailing Address - Phone:443-362-0290
Mailing Address - Fax:
Practice Address - Street 1:2015 MARTINS GRANT CT
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-1932
Practice Address - Country:US
Practice Address - Phone:443-362-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist