Provider Demographics
NPI:1538234505
Name:CONSIDINE, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CONSIDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CONSIDINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MAC
Mailing Address - Street 1:608 BOSLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4029
Mailing Address - Country:US
Mailing Address - Phone:410-494-1152
Mailing Address - Fax:
Practice Address - Street 1:608 BOSLEY AVENUE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-494-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist