Provider Demographics
NPI:1285324525
Name:SHANNON, LEENNA R
Entity type:Individual
Prefix:
First Name:LEENNA
Middle Name:R
Last Name:SHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N WEST SHORE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5747
Mailing Address - Country:US
Mailing Address - Phone:813-751-6078
Mailing Address - Fax:
Practice Address - Street 1:2202 N WEST SHORE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5747
Practice Address - Country:US
Practice Address - Phone:813-751-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician