Healthcare Provider Details

I. General information

NPI: 1164225785
Provider Name (Legal Business Name): SHANNON HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST STE 2200
PHILADELPHIA PA
19103-6221
US

IV. Provider business mailing address

201 S 11TH ST APT 629
PHILADELPHIA PA
19107-6218
US

V. Phone/Fax

Practice location:
  • Phone: 267-519-0241
  • Fax:
Mailing address:
  • Phone: 317-498-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: