Provider Demographics
NPI:1932789815
Name:SHANNON, DEVON THOMAS
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:THOMAS
Last Name:SHANNON
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 1:1626 GLENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1951
Mailing Address - Country:US
Mailing Address - Phone:513-508-9717
Mailing Address - Fax:
Practice Address - Street 1:2201 CHILDRENS WAY STE 1221
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3164
Practice Address - Country:US
Practice Address - Phone:615-322-0738
Practice Address - Fax:615-322-4586
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program