MEDICARE: SHANNON CHAPLO PHD

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	103TC0700X	Clinical Psychologist	5516	NC

General Provider Information

NPI Number	:	1952991481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON CHAPLO PHD

Provider Business Mailing Address
First Line	:	135 BEACONWOOD LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4411
Country	:	US
Telephone Number	:	608-359-3822
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NW MAYNARD RD STE 140
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-8707
Country	:	US
Telephone Number	:	919-428-2766
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	10/22/2023

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