Provider Demographics
NPI:1255955514
Name:LOWRY, SHAN
Entity type:Individual
Prefix:MRS
First Name:SHAN
Middle Name:
Last Name:LOWRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHAN
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 TORTOISE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7635
Mailing Address - Country:US
Mailing Address - Phone:904-868-4310
Mailing Address - Fax:
Practice Address - Street 1:1007 TORTOISE WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7635
Practice Address - Country:US
Practice Address - Phone:904-868-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator