Provider Demographics
NPI:1275253577
Name:DISNEY, SHANNON (MS, SLP-CF)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DISNEY
Suffix:
Gender:F
Credentials:MS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3839
Mailing Address - Country:US
Mailing Address - Phone:757-648-2120
Mailing Address - Fax:
Practice Address - Street 1:957 S BIRDNECK RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4801
Practice Address - Country:US
Practice Address - Phone:757-648-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist