Healthcare Provider Details

I. General information

NPI: 1972848521
Provider Name (Legal Business Name): SHANNON GRIFFIN HORNICH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WINCHESTER AVE
MARTINSBURG WV
25401-1683
US

IV. Provider business mailing address

PO BOX 180
SHENANDOAH JUNCTION WV
25442-0180
US

V. Phone/Fax

Practice location:
  • Phone: 304-290-4262
  • Fax: 304-212-0627
Mailing address:
  • Phone: 301-704-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: