Provider Demographics
NPI:1972345387
Name:SHEDD, SHANNON (PT, DPT, CWS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:SHEDD
Suffix:
Gender:F
Credentials:PT, DPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17011 CAMBERWELL GREEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1815
Mailing Address - Country:US
Mailing Address - Phone:562-216-3156
Mailing Address - Fax:
Practice Address - Street 1:17011 CAMBERWELL GREEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1815
Practice Address - Country:US
Practice Address - Phone:562-216-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist