Provider Demographics
NPI:1447905963
Name:FLANIGAN, SHANE THOMAS
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:THOMAS
Last Name:FLANIGAN
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 1:138 DAISY LN
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9627
Mailing Address - Country:US
Mailing Address - Phone:530-927-8293
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY HOSPITAL RD STE 109
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9173
Practice Address - Country:US
Practice Address - Phone:530-927-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator