Provider Demographics
NPI:1568671147
Name:MCMAHON, SHANNON COOPER (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:COOPER
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 MADERIA CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5595
Mailing Address - Country:US
Mailing Address - Phone:321-242-2501
Mailing Address - Fax:
Practice Address - Street 1:100 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8302
Practice Address - Country:US
Practice Address - Phone:321-727-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL3042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer