Healthcare Provider Details

I. General information

NPI: 1235478926
Provider Name (Legal Business Name): SHANNON BALLENTINE & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 HARRINGTON GROVE DR
RALEIGH NC
27613-5706
US

IV. Provider business mailing address

5716 HARRINGTON GROVE DR
RALEIGH NC
27613-5706
US

V. Phone/Fax

Practice location:
  • Phone: 919-815-4098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: LAMAR SHANNON
Title or Position: CEO
Credential:
Phone: 919-815-4098