Provider Demographics
NPI:1376174045
Name:CIRCLE, SHANNON LEEANNE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEEANNE
Last Name:CIRCLE
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 1:4841 HARLOU DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1620
Mailing Address - Country:US
Mailing Address - Phone:937-344-0476
Mailing Address - Fax:
Practice Address - Street 1:118 W 1ST ST STE 300
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1111
Practice Address - Country:US
Practice Address - Phone:937-223-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator