Provider Demographics
NPI:1649910845
Name:NORDT, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:NORDT
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 1:3999 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3015
Mailing Address - Country:US
Mailing Address - Phone:717-805-0266
Mailing Address - Fax:
Practice Address - Street 1:4755 LINGLESTOWN RD STE 206
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8547
Practice Address - Country:US
Practice Address - Phone:717-400-1871
Practice Address - Fax:717-814-5260
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1629549928OtherINSURANCE