Provider Demographics
NPI:1982429429
Name:DUKE, SHANNA S (CPT)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:S
Last Name:DUKE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 BD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:TX
Mailing Address - Zip Code:75758-7322
Mailing Address - Country:US
Mailing Address - Phone:903-714-9138
Mailing Address - Fax:
Practice Address - Street 1:890 BD RANCH RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758-7322
Practice Address - Country:US
Practice Address - Phone:903-714-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47696052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer