Provider Demographics
NPI:1699812172
Name:MAHON, CHRISTINE SHANNON (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SHANNON
Last Name:MAHON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:STE #106
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-901-0122
Mailing Address - Fax:925-901-0199
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:STE #106
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-901-0122
Practice Address - Fax:925-901-0199
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1073231H00000X
CAHA2370237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00749ZMedicare ID - Type UnspecifiedPROVIDER #