MEDICARE: JENNIFER CHENG SHANNON MD

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
1	2084P0800X	Psychiatry Physician	MD00043903	WA

General Provider Information

NPI Number	:	1356362842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHENG SHANNON MD

Provider Business Mailing Address
First Line	:	15600 NE 8TH ST STE B1267
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98008-3927
Country	:	US
Telephone Number	:	360-918-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 CATON WAY SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1105
Country	:	US
Telephone Number	:	360-455-4571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	06/14/2024

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