Provider Demographics
NPI:1790769289
Name:JOYCE, SHANNON M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:JOYCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5926 CRAWFORDSVILLE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3722
Mailing Address - Country:US
Mailing Address - Phone:317-653-2730
Mailing Address - Fax:317-623-1440
Practice Address - Street 1:5926 CRAWFORDSVILLE RD UNIT B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3722
Practice Address - Country:US
Practice Address - Phone:317-653-2730
Practice Address - Fax:317-623-1440
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045328A207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200185170Medicaid
190530Medicare PIN
IN940550TTMedicare PIN
ING69899Medicare UPIN
IN200185170Medicaid