Provider Demographics
NPI:1376289199
Name:BAIRD, SHANNON MICHAEL
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:MICHAEL
Last Name:BAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0509
Mailing Address - Country:US
Mailing Address - Phone:530-223-4567
Mailing Address - Fax:530-223-4566
Practice Address - Street 1:2329 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0509
Practice Address - Country:US
Practice Address - Phone:530-223-4567
Practice Address - Fax:530-223-4566
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8407237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013239037Medicaid