Provider Demographics
NPI:1477381440
Name:SHANNON, DORCAS CHIRON
Entity type:Individual
Prefix:
First Name:DORCAS
Middle Name:CHIRON
Last Name:SHANNON
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 1:5592 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137
Mailing Address - Country:US
Mailing Address - Phone:216-571-6302
Mailing Address - Fax:
Practice Address - Street 1:5592 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44137
Practice Address - Country:US
Practice Address - Phone:216-571-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals