Provider Demographics
NPI:1912016585
Name:KRALL, SHANNON MARIE (MED PC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:KRALL
Suffix:
Gender:F
Credentials:MED PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23240 CHAGRIN BLVD.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5404
Mailing Address - Country:US
Mailing Address - Phone:216-262-9007
Mailing Address - Fax:216-292-7352
Practice Address - Street 1:23240 CHAGRIN BLVD.
Practice Address - Street 2:SUITE 500
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5404
Practice Address - Country:US
Practice Address - Phone:216-262-9007
Practice Address - Fax:216-292-7352
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC500776101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor