Healthcare Provider Details

I. General information

NPI: 1447180864
Provider Name (Legal Business Name): SHANNON LYNN DUNCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8013
NEWCOMB NM
87455-8013
US

IV. Provider business mailing address

PO BOX 8013
NEWCOMB NM
87455-8013
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-1832
  • Fax:
Mailing address:
  • Phone: 505-609-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA22020
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: