Individual
SHANNON WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
449 FOREST AVE, PORTLAND, ME 04101-2029
(207) 329-4386
Mailing address
59 SAINT GEORGE ST, PORTLAND, ME 04103-4019
(207) 329-4386
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT4634
ME
Other
Enumeration date
05/26/2015
Last updated
05/26/2015
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