Provider Demographics
NPI:1235935362
Name:DR. SHANNON PARKS D.O. LLC
Entity type:Organization
Organization Name:DR. SHANNON PARKS D.O. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-450-1567
Mailing Address - Street 1:55 N GILBERT ST STE 1103
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4956
Mailing Address - Country:US
Mailing Address - Phone:732-447-2545
Mailing Address - Fax:732-447-2554
Practice Address - Street 1:55 N GILBERT ST STE 1103
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4956
Practice Address - Country:US
Practice Address - Phone:732-447-2545
Practice Address - Fax:732-447-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty