Individual
FREDERICK SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2130 SW JEFFERSON ST STE 200, PORTLAND, OR 97201-7710
(971) 266-6910
Mailing address
5541 SE HENDERSON ST, PORTLAND, OR 97206-8232
(413) 262-3228
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
A824721
OR
Other
Enumeration date
05/13/2026
Last updated
05/13/2026
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