Provider Demographics
NPI:1326435264
Name:SHANNON, LEANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:MARIE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LEANN
Other - Middle Name:MARIE
Other - Last Name:SAGMEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N HIATUS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5213
Mailing Address - Country:US
Mailing Address - Phone:954-437-4800
Mailing Address - Fax:954-437-6628
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-437-4800
Practice Address - Fax:954-437-6628
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV336172085R0202X
390200000X
FLME1458552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program