Provider Demographics
NPI:1801359674
Name:SHANNON, TONYA MARIA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIA
Last Name:SHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 POMEROY RD SE APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3523
Mailing Address - Country:US
Mailing Address - Phone:202-760-7945
Mailing Address - Fax:
Practice Address - Street 1:3072 STANTON RD SE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7891
Practice Address - Country:US
Practice Address - Phone:202-604-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide