Individual
EMILY GRACE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
4700 MILLENIA BLVD STE 500, ORLANDO, FL 32839-6019
(407) 349-8353
(720) 640-0405
Mailing address
4700 MILLENIA BLVD STE 500, ORLANDO, FL 32839-6019
(407) 349-8353
(720) 640-0405
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPO05062
ABC
—
Enumeration date
08/19/2022
Last updated
02/01/2024
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