Provider Demographics
NPI:1740860477
Name:BANNISH, SHENNA HAILA (DO)
Entity type:Individual
Prefix:
First Name:SHENNA
Middle Name:HAILA
Last Name:BANNISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AUCOCISCO LN
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-4261
Mailing Address - Country:US
Mailing Address - Phone:413-454-7897
Mailing Address - Fax:
Practice Address - Street 1:12 AUCOCISCO LN
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-4261
Practice Address - Country:US
Practice Address - Phone:413-454-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program