Provider Demographics
NPI:1356330989
Name:DIXON, SHANNAN MARIE (MS)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W REDWOOD ST
Mailing Address - Street 2:SUITE 570
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1542
Mailing Address - Country:US
Mailing Address - Phone:410-706-4713
Mailing Address - Fax:410-706-1644
Practice Address - Street 1:655 W REDWOOD ST
Practice Address - Street 2:SUITE 570
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1542
Practice Address - Country:US
Practice Address - Phone:410-706-4713
Practice Address - Fax:410-706-1644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS