Provider Demographics
NPI:1467653832
Name:SHANNON, MELANIE RENEE
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RENEE
Last Name:SHANNON
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 1:2079 DISTRICT RD
Mailing Address - Street 2:
Mailing Address - City:STONEBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16153-2011
Mailing Address - Country:US
Mailing Address - Phone:724-376-2649
Mailing Address - Fax:
Practice Address - Street 1:2079 DISTRICT RD
Practice Address - Street 2:
Practice Address - City:STONEBORO
Practice Address - State:PA
Practice Address - Zip Code:16153-2011
Practice Address - Country:US
Practice Address - Phone:724-376-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005717L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist