Provider Demographics
NPI:1710870217
Name:SHANNON, MOLLY KATHLEEN (PRC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5518
Mailing Address - Country:US
Mailing Address - Phone:810-238-0483
Mailing Address - Fax:
Practice Address - Street 1:128 N WARREN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1548
Practice Address - Country:US
Practice Address - Phone:989-754-5754
Practice Address - Fax:989-754-0315
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist