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NPI Code Detail

MEDICARE: SHANNON ELIZABETH BASHORE MS

MEDICARE: SHANNON ELIZABETH BASHORE MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1336647890
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ELIZABETH BASHORE MS
Provider Business Mailing Address
First Line : 102 ELSBREE ST
Second Line :
City : SAYRE
State : PA
Zip : 18840-1209
Country : US
Telephone Number : 607-733-7661
Fax Number :
Provider Business Practice Location Address
First Line : 1149 SULLIVAN ST
Second Line :
City : ELMIRA
State : NY
Zip : 14901-1670
Country : US
Telephone Number : 607-733-7661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2018
Last Update Date : 01/30/2018

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