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Individual

MITSUKO P. SHANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
706 W KING ST, KINGS MOUNTAIN, NC 28086-2708
(980) 487-5470
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9300804
NC
2084P0804X
Child & Adolescent Psychiatry Physician
9300804
NC

Other

Enumeration date
07/19/2006
Last updated
07/15/2024
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