Provider Demographics
NPI:1124424452
Name:SCHULTZ, SHANNON KILEY (MA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KILEY
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:KILEY
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:816 WILLARD ST
Mailing Address - Street 2:APT 114
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7496
Mailing Address - Country:US
Mailing Address - Phone:703-595-3101
Mailing Address - Fax:
Practice Address - Street 1:769 PLAIN ST
Practice Address - Street 2:SUITE I
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2118
Practice Address - Country:US
Practice Address - Phone:781-834-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health