Healthcare Provider Details

I. General information

NPI: 1811173099
Provider Name (Legal Business Name): SHANNON SHIFFLETT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 GIDDINGS AVE STE M2
ANNAPOLIS MD
21401-1411
US

IV. Provider business mailing address

24 STEELE AVE
ANNAPOLIS MD
21401-2807
US

V. Phone/Fax

Practice location:
  • Phone: 410-991-3651
  • Fax:
Mailing address:
  • Phone: 410-991-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11472
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: