Provider Demographics
NPI:1700113123
Name:MAYS, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MAYS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398833
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75339-8833
Mailing Address - Country:US
Mailing Address - Phone:214-325-5162
Mailing Address - Fax:
Practice Address - Street 1:191 S CORINTH STREET RD
Practice Address - Street 2:STE C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-3465
Practice Address - Country:US
Practice Address - Phone:214-325-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator