Individual
DEVIOUS SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
31 BASCOM DR, SAINT LOUIS, MO 63135-1101
(314) 680-4612
Mailing address
7220 N LINDBERGH BLVD # 20, HAZELWOOD, MO 63042-2019
(314) 680-4612
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
02/11/2025
Last updated
06/03/2025
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