Provider Demographics
NPI:1295806628
Name:SLAYTON, SHANNON ALYSSA KANE (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ALYSSA KANE
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOSPITAL DR
Mailing Address - Street 2:BRIDGTON PEDIATRICS
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1167
Mailing Address - Country:US
Mailing Address - Phone:207-647-6423
Mailing Address - Fax:207-647-6016
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:BRIDGTON PEDIATRICS
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1167
Practice Address - Country:US
Practice Address - Phone:207-647-6423
Practice Address - Fax:207-647-6016
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics