Provider Demographics
NPI:1942592332
Name:PYE, SHANNA D
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:D
Last Name:PYE
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:P O BOX 391302
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3995
Mailing Address - Country:US
Mailing Address - Phone:678-774-9793
Mailing Address - Fax:
Practice Address - Street 1:500 WILOAKS DR
Practice Address - Street 2:G
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3995
Practice Address - Country:US
Practice Address - Phone:678-774-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2011016351332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies