Healthcare Provider Details

I. General information

NPI: 1720714694
Provider Name (Legal Business Name): SHANNON MARIE CODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MARIE HOFMANN

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N FRESNO ST STE 202
FRESNO CA
93710-5280
US

IV. Provider business mailing address

5560 W MILLBRAE AVE
FRESNO CA
93722-8810
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-0100
  • Fax:
Mailing address:
  • Phone: 760-975-9939
  • Fax: 760-509-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133511
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: