Provider Demographics
NPI:1851152300
Name:DE ANGELIS, SHANNON LEE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:DE ANGELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20295 MARINER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7069
Mailing Address - Country:US
Mailing Address - Phone:503-840-4606
Mailing Address - Fax:
Practice Address - Street 1:548 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3184
Practice Address - Country:US
Practice Address - Phone:541-388-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist