Provider Demographics
NPI:1962106948
Name:HAMMOND, SHANNON (LMBT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 PROFESSIONAL CT STE 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-1926
Mailing Address - Country:US
Mailing Address - Phone:919-899-7383
Mailing Address - Fax:
Practice Address - Street 1:4913 PROFESSIONAL CT STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1926
Practice Address - Country:US
Practice Address - Phone:919-899-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist