Provider Demographics
NPI:1578005898
Name:SHANNON, MICHAEL J (BC-HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SHANNON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 WARNER AVE # 217
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-5177
Mailing Address - Country:US
Mailing Address - Phone:714-465-9578
Mailing Address - Fax:714-465-9857
Practice Address - Street 1:4911 WARNER AVE # 217
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-5177
Practice Address - Country:US
Practice Address - Phone:714-465-9578
Practice Address - Fax:714-465-9857
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA-1128237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist