Provider Demographics
NPI:1700944204
Name:DEVOE, SHANNON THEOBALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:THEOBALD
Last Name:DEVOE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD CHARLTON RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-1407
Mailing Address - Country:US
Mailing Address - Phone:508-987-0256
Mailing Address - Fax:
Practice Address - Street 1:12 OLD CHARLTON RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-1407
Practice Address - Country:US
Practice Address - Phone:508-987-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11596600OtherMAGELLAN BEHAVIORAL HEALT
91531OtherCIGNA BEHAVIORAL HEALTH
1011430OtherBEACON HEALTH STRATEGIES
EW03173OtherBLUE CROSS BLUE SHIELD
004155OtherVALUE OPTIONS
1011430OtherBEACON HEALTH STRATEGIES