Provider Demographics
NPI:1619028321
Name:COX, SHANON AUTUMN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SHANON
Middle Name:AUTUMN
Last Name:COX
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:SHANON
Other - Middle Name:
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:234 NW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2064
Mailing Address - Country:US
Mailing Address - Phone:425-923-5496
Mailing Address - Fax:206-789-8867
Practice Address - Street 1:459 N 36TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8630
Practice Address - Country:US
Practice Address - Phone:425-923-5496
Practice Address - Fax:206-789-8867
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist