Provider Demographics
NPI:1780244707
Name:DAVIS, SHANNON N
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:DAVIS
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 1:720 BEAUFORT ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-1741
Mailing Address - Country:US
Mailing Address - Phone:315-726-0399
Mailing Address - Fax:
Practice Address - Street 1:720 BEAUFORT ST APT 6
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-1741
Practice Address - Country:US
Practice Address - Phone:315-726-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management