Provider Demographics
NPI:1407880164
Name:SHANNON, DIANE W (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:W
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHANNON HEALTHCARE COMM.
Mailing Address - Street 2:31 JORDAN RD.
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-879-0328
Mailing Address - Fax:
Practice Address - Street 1:SHANNON HEALTHCARE COMMUNICATIONS
Practice Address - Street 2:31 JORDAN RD.
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-879-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine