Provider Demographics
NPI:1972801975
Name:THOMAS, SHANNON
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 W STATE ROAD 46 # 325
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9230
Mailing Address - Country:US
Mailing Address - Phone:386-216-5174
Mailing Address - Fax:
Practice Address - Street 1:667 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8022
Practice Address - Country:US
Practice Address - Phone:386-215-5174
Practice Address - Fax:888-558-2226
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator