Provider Demographics
NPI:1740569466
Name:SHANNON, PARISSHA (PARISSHA SHANNON)
Entity Type:Individual
Prefix:MISS
First Name:PARISSHA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PARISSHA SHANNON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 ROSEWOOD BLVD
Mailing Address - Street 2:D3
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4029
Mailing Address - Country:US
Mailing Address - Phone:440-258-3076
Mailing Address - Fax:
Practice Address - Street 1:1581 ROSEWOOD BLVD
Practice Address - Street 2:D3
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4029
Practice Address - Country:US
Practice Address - Phone:440-258-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401165071110171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications