Provider Demographics
NPI:1598522906
Name:DEGNAN, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:DEGNAN
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 1:1038 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5741
Mailing Address - Country:US
Mailing Address - Phone:937-441-3878
Mailing Address - Fax:
Practice Address - Street 1:1038 SARATOGA DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5741
Practice Address - Country:US
Practice Address - Phone:937-441-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health