Provider Demographics
NPI:1790034924
Name:PEREZ, SHANNON R (IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:PEREZ
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1906
Mailing Address - Country:US
Mailing Address - Phone:502-380-5403
Mailing Address - Fax:502-380-5403
Practice Address - Street 1:4534 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1906
Practice Address - Country:US
Practice Address - Phone:502-380-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN