Provider Demographics
NPI:1588860704
Name:TRZIL, SHANNON DAVOCK (OTR/L)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAVOCK
Last Name:TRZIL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3456
Mailing Address - Country:US
Mailing Address - Phone:901-754-8919
Mailing Address - Fax:
Practice Address - Street 1:5118 PARK AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5720
Practice Address - Country:US
Practice Address - Phone:901-761-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT3772174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36550501Medicare PIN