Provider Demographics
NPI:1962631457
Name:PARKS, SHANNON (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N GILBERT ST
Mailing Address - Street 2:SUITE 2203
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4904
Mailing Address - Country:US
Mailing Address - Phone:732-939-6381
Mailing Address - Fax:
Practice Address - Street 1:55 N GILBERT ST
Practice Address - Street 2:SUITE 2203
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4904
Practice Address - Country:US
Practice Address - Phone:732-939-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB087056002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry