Provider Demographics
NPI:1548420631
Name:SHANNON, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:MCNABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6300 W PARKER RD STE G28
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8336
Mailing Address - Country:US
Mailing Address - Phone:469-592-8557
Mailing Address - Fax:469-592-8558
Practice Address - Street 1:6300 W PARKER RD STE G28
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8336
Practice Address - Country:US
Practice Address - Phone:469-592-8557
Practice Address - Fax:469-592-8558
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9602207VE0102X
WABC60288888207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology