Individual
SHANNON SALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 BOLAND ST # 210, FORT WORTH, TX 76107-1263
(817) 529-8514
(469) 453-5075
Mailing address
111 BOLAND ST # 210, FORT WORTH, TX 76107-1263
(817) 529-8514
(469) 453-5075
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1111111111
NOTAPPLICABLE
—
Enumeration date
08/19/2021
Last updated
08/19/2021
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