Provider Demographics
NPI:1881007607
Name:LEVIN, SHANNON (CPO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 UNION ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2458
Mailing Address - Country:US
Mailing Address - Phone:503-339-7096
Mailing Address - Fax:
Practice Address - Street 1:441 UNION ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2458
Practice Address - Country:US
Practice Address - Phone:503-339-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier