Healthcare Provider Details

I. General information

NPI: 1417864067
Provider Name (Legal Business Name): SHANNON MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 FOREST DR
ANNAPOLIS MD
21403-1482
US

IV. Provider business mailing address

439 POPLAR LEAF DR
EDGEWATER MD
21037-3213
US

V. Phone/Fax

Practice location:
  • Phone: 410-280-9788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: