Healthcare Provider Details

I. General information

NPI: 1386518348
Provider Name (Legal Business Name): SHANNON PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 BIRKSHIRE WAY
FLETCHER NC
28732-9604
US

IV. Provider business mailing address

78 BIRKSHIRE WAY
FLETCHER NC
28732-9604
US

V. Phone/Fax

Practice location:
  • Phone: 425-765-2237
  • Fax:
Mailing address:
  • Phone: 425-765-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15743
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: