Provider Demographics
NPI:1952788028
Name:ISLEY, SHANNON M
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:ISLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:PICAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 E 82ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3100
Mailing Address - Country:US
Mailing Address - Phone:907-344-3338
Mailing Address - Fax:907-344-8020
Practice Address - Street 1:615 E 82ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3100
Practice Address - Country:US
Practice Address - Phone:907-344-3338
Practice Address - Fax:907-344-8020
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist