Provider Demographics
NPI:1326439092
Name:CAVENDER, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CAVENDER
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 1:1514 THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-5026
Mailing Address - Country:US
Mailing Address - Phone:620-778-3226
Mailing Address - Fax:
Practice Address - Street 1:138 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:OK
Practice Address - Zip Code:74331-1822
Practice Address - Country:US
Practice Address - Phone:918-257-4244
Practice Address - Fax:918-257-4247
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator