Provider Demographics
NPI:1851865307
Name:HEINDEL, SHANNON (CLE)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HEINDEL
Suffix:
Gender:F
Credentials:CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43400 POSTRAIL SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4600
Mailing Address - Country:US
Mailing Address - Phone:571-421-6971
Mailing Address - Fax:
Practice Address - Street 1:43400 POSTRAIL SQ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4600
Practice Address - Country:US
Practice Address - Phone:571-421-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN