Provider Demographics
NPI:1649068487
Name:CANNON, SHANNON ANNA (IHP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANNA
Last Name:CANNON
Suffix:
Gender:
Credentials:IHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 E SETTLERS TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-7801
Mailing Address - Country:US
Mailing Address - Phone:516-398-3838
Mailing Address - Fax:
Practice Address - Street 1:11921 E SETTLERS TRL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-7801
Practice Address - Country:US
Practice Address - Phone:516-398-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator