Provider Demographics
NPI:1932595162
Name:RAYMAN, SHANNON (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:RAYMAN
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 1:328 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:FRANCESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03043-3501
Mailing Address - Country:US
Mailing Address - Phone:757-651-1530
Mailing Address - Fax:757-651-1530
Practice Address - Street 1:1253 MAKALAPA GATE RD
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4479
Practice Address - Country:US
Practice Address - Phone:888-683-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH18687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3112488Medicaid