Individual
SHANNON RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
VICE PRESIDENT OF OP
Contact information
Practice address
570 MEMORIAL CIR STE 110, ORMOND BEACH, FL 32174-5063
(386) 951-5571
(386) 287-5776
Mailing address
570 MEMORIAL CIR STE 110, ORMOND BEACH, FL 32174-5063
(386) 951-5571
(386) 287-5776
Taxonomy
Speciality
Code
Description
License number
State
246QL0900X
Laboratory Management Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2251415
CLIA
FL
Enumeration date
03/03/2022
Last updated
03/03/2022
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