Healthcare Provider Details

I. General information

NPI: 1376289199
Provider Name (Legal Business Name): MR. SHANNON MICHAEL BAIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 HILLTOP DR
REDDING CA
96002-0509
US

IV. Provider business mailing address

2329 HILLTOP DR
REDDING CA
96002-0509
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-4567
  • Fax: 530-223-4566
Mailing address:
  • Phone: 530-223-4567
  • Fax: 530-223-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: