Provider Demographics
NPI:1447594288
Name:SHANNON L SNIFF MD PLLC
Entity Type:Organization
Organization Name:SHANNON L SNIFF MD PLLC
Other - Org Name:FORT BEND PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-499-9402
Mailing Address - Street 1:4501 CARTWRIGHT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3534
Mailing Address - Country:US
Mailing Address - Phone:281-499-9402
Mailing Address - Fax:281-499-9360
Practice Address - Street 1:4501 CARTWRIGHT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3534
Practice Address - Country:US
Practice Address - Phone:281-499-9402
Practice Address - Fax:281-499-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0471261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280625901Medicaid