Provider Demographics
NPI:1588415145
Name:PARKER, SHANNON DEONCE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DEONCE
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 BUCHANAN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-5407
Mailing Address - Country:US
Mailing Address - Phone:301-357-9761
Mailing Address - Fax:
Practice Address - Street 1:7111 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-5407
Practice Address - Country:US
Practice Address - Phone:301-357-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty