Provider Demographics
NPI:1336225762
Name:ALBERT, SHANNON E (BS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:ALBERT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 52ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3221
Mailing Address - Country:US
Mailing Address - Phone:727-520-0735
Mailing Address - Fax:
Practice Address - Street 1:PEMHS, INC.
Practice Address - Street 2:11254 58TH STREET
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2213
Practice Address - Country:US
Practice Address - Phone:727-545-6477
Practice Address - Fax:727-545-6464
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator