Provider Demographics
NPI:1467971622
Name:PARKER, SHANNON MARIA (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIA
Last Name:PARKER
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2742
Mailing Address - Country:US
Mailing Address - Phone:216-470-6274
Mailing Address - Fax:
Practice Address - Street 1:10916 THORNTON AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2742
Practice Address - Country:US
Practice Address - Phone:216-470-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid