Provider Demographics
NPI:1841333218
Name:CLOYD, SHANNA RENEE (LM)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:RENEE
Last Name:CLOYD
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-8604
Mailing Address - Country:US
Mailing Address - Phone:432-556-5518
Mailing Address - Fax:432-687-4645
Practice Address - Street 1:1211 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6173
Practice Address - Country:US
Practice Address - Phone:432-687-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05020175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay