Provider Demographics
NPI:1477895209
Name:LUNDY, SHANNON LAURA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LAURA
Last Name:LUNDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 VISTA DEL REY NE UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-8100
Mailing Address - Country:US
Mailing Address - Phone:505-379-2353
Mailing Address - Fax:
Practice Address - Street 1:3400 CONSTITUTION AVE NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1243
Practice Address - Country:US
Practice Address - Phone:505-379-2353
Practice Address - Fax:505-299-4740
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1259103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist