Provider Demographics
NPI:1730644378
Name:NEIL, SHANNON FAYE (HYGIENIST)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:FAYE
Last Name:NEIL
Suffix:
Gender:F
Credentials:HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3015
Mailing Address - Country:US
Mailing Address - Phone:970-252-8896
Mailing Address - Fax:
Practice Address - Street 1:87 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3015
Practice Address - Country:US
Practice Address - Phone:970-252-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025313124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO002025313Medicaid