Provider Demographics
NPI:1821896002
Name:SALAS, SHANNON NICOLE (CSFA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:SALAS
Suffix:
Gender:
Credentials:CSFA
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:SNEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:10003 BRADWELL PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5158
Mailing Address - Country:US
Mailing Address - Phone:813-759-3688
Mailing Address - Fax:
Practice Address - Street 1:7171 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2665
Practice Address - Country:US
Practice Address - Phone:813-558-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL162672246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant