Provider Demographics
NPI:1740626423
Name:BROWN, SHANNON STANTON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:STANTON
Last Name:BROWN
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 1:500 N. ACADEMY STREET
Mailing Address - Street 2:BLDG-A
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556
Mailing Address - Country:US
Mailing Address - Phone:843-355-5533
Mailing Address - Fax:
Practice Address - Street 1:500 N ACADEMY ST
Practice Address - Street 2:BLDG-A
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3408
Practice Address - Country:US
Practice Address - Phone:843-355-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist