Provider Demographics
NPI:1457068348
Name:SUMNER, SHANNON L
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:L
Last Name:SUMNER
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 1:6503 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-3526
Mailing Address - Country:US
Mailing Address - Phone:813-252-7910
Mailing Address - Fax:
Practice Address - Street 1:2995 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3012
Practice Address - Country:US
Practice Address - Phone:813-252-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT21805183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician