Provider Demographics
NPI:1194307298
Name:LEVITT, SHANNON LISA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LISA
Last Name:LEVITT
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 S ELDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4828
Mailing Address - Country:US
Mailing Address - Phone:720-202-4065
Mailing Address - Fax:
Practice Address - Street 1:2316 S ELDRIDGE CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4828
Practice Address - Country:US
Practice Address - Phone:720-202-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date: