Provider Demographics
NPI:1356016778
Name:KENNEDY, SHANNA (CPT II)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CPT II
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17813 TROPICAL COVE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3671
Mailing Address - Country:US
Mailing Address - Phone:813-618-7765
Mailing Address - Fax:
Practice Address - Street 1:1779 BROAD WINGED HAWK DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4957
Practice Address - Country:US
Practice Address - Phone:813-618-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20-0325R11246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy