Provider Demographics
NPI:1992474662
Name:DUNPHY, SHANNON CHRISTINE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:DUNPHY
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 1:2854 EUSTON RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3311
Mailing Address - Country:US
Mailing Address - Phone:407-212-0098
Mailing Address - Fax:
Practice Address - Street 1:2854 EUSTON RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3311
Practice Address - Country:US
Practice Address - Phone:407-212-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator