Provider Demographics
NPI:1407582885
Name:KURI, SHANNALEE ANN
Entity Type:Individual
Prefix:
First Name:SHANNALEE
Middle Name:ANN
Last Name:KURI
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 1:1100 CHAPLINE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2999
Mailing Address - Country:US
Mailing Address - Phone:304-830-9323
Mailing Address - Fax:304-232-0513
Practice Address - Street 1:1100 CHAPLINE ST FL 1
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2999
Practice Address - Country:US
Practice Address - Phone:304-214-9350
Practice Address - Fax:304-232-0513
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16-903175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV16-903OtherCERTIFICATION BOARD