Individual
LISA R SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5 BRIDGE CT, MIDDLETOWN, DE 19709-9285
(302) 468-9416
Mailing address
5 BRIDGE CT, MIDDLETOWN, DE 19709-9285
(302) 468-9416
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT0003080
DE
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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