Provider Demographics
NPI:1952650293
Name:STEWART, SHANNON CHRISTINE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:STEWART
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 1:712 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1038
Mailing Address - Country:US
Mailing Address - Phone:267-254-2453
Mailing Address - Fax:
Practice Address - Street 1:712 SPRING LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1038
Practice Address - Country:US
Practice Address - Phone:267-254-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist