Individual
DR. SHIVAUN GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
940 BELMONT ST, BROCKTON, MA 02301-5596
(774) 826-2458
Mailing address
940 BELMONT ST, BROCKTON, MA 02301-5596
(774) 826-2458
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
267376
MA
2084P0800X
Psychiatry Physician
MD60945827
WA
Other
Enumeration date
06/24/2016
Last updated
07/09/2021
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