Provider Demographics
NPI:1891511473
Name:PAUL, SHANNAN MARIE
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:MARIE
Last Name:PAUL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 S RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-8901
Mailing Address - Country:US
Mailing Address - Phone:209-888-6595
Mailing Address - Fax:209-888-6596
Practice Address - Street 1:7224 S RECOVERY RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-8901
Practice Address - Country:US
Practice Address - Phone:209-888-6595
Practice Address - Fax:209-888-6596
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist