Provider Demographics
NPI:1306606355
Name:SHOEMAKER, SHANNON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18222 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1496
Mailing Address - Country:US
Mailing Address - Phone:301-820-0504
Mailing Address - Fax:
Practice Address - Street 1:18222 PRESTWICK DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1496
Practice Address - Country:US
Practice Address - Phone:301-820-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional