Provider Demographics
NPI:1477693935
Name:SHANNON, SHEILA CHANELL
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:CHANELL
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 1:122 N JONHSON ST
Mailing Address - Street 2:
Mailing Address - City:COTTON PLANT
Mailing Address - State:AR
Mailing Address - Zip Code:72036
Mailing Address - Country:US
Mailing Address - Phone:870-459-1155
Mailing Address - Fax:
Practice Address - Street 1:893 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:AR
Practice Address - Zip Code:72006-5119
Practice Address - Country:US
Practice Address - Phone:870-347-8108
Practice Address - Fax:870-377-1457
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator