Provider Demographics
NPI:1932709979
Name:VINSON, SHANNON
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:
Last Name:VINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12118 PARADE PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-3534
Mailing Address - Country:US
Mailing Address - Phone:832-834-7304
Mailing Address - Fax:832-327-7987
Practice Address - Street 1:12118 PARADE PARK PLACE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-3534
Practice Address - Country:US
Practice Address - Phone:832-834-7304
Practice Address - Fax:832-327-7987
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant