Provider Demographics
NPI:1316526429
Name:MAY-ROGERS, SHALLON MICHELLE (IBCLC, PARAMEDIC)
Entity type:Individual
Prefix:
First Name:SHALLON
Middle Name:MICHELLE
Last Name:MAY-ROGERS
Suffix:
Gender:F
Credentials:IBCLC, PARAMEDIC
Other - Prefix:
Other - First Name:SHALLON
Other - Middle Name:MICHELLE
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED PARAMEDIC
Mailing Address - Street 1:317 SAN MATTEO ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7076
Mailing Address - Country:US
Mailing Address - Phone:512-809-5950
Mailing Address - Fax:
Practice Address - Street 1:317 SAN MATTEO ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-7076
Practice Address - Country:US
Practice Address - Phone:512-809-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145876146L00000X
TXL-300797174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic