Provider Demographics
NPI:1194599530
Name:HILL, SHANNON CORRINE (PROSTHETIC PROVIDER)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CORRINE
Last Name:HILL
Suffix:
Gender:F
Credentials:PROSTHETIC PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 SHAVANO OAK STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4029
Mailing Address - Country:US
Mailing Address - Phone:210-872-6511
Mailing Address - Fax:
Practice Address - Street 1:4714 SHAVANO OAK STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4029
Practice Address - Country:US
Practice Address - Phone:210-872-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier