Individual
MADELINE TERESA SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1455 N MELROSE DR APT 114, VISTA, CA 92083-4875
(818) 425-7447
Mailing address
1455 N MELROSE DR APT 114, VISTA, CA 92083-4875
(818) 425-7447
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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