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General NPI Number Information
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NPI Number | 1235935362
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Entity Type | Organization
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Legal Business Name | DR. SHANNON PARKS D.O. LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 55 N GILBERT ST STE 1103
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4956
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Country | US
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Telephone | 732-447-2545
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Fax | 732-447-2554
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Provider Business Mailing Address
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Address Line | 55 N GILBERT ST STE 1103
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4956
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Country | US
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Telephone | 732-447-2545
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Fax | 732-447-2554
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Authorized Official
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Title or Position | CEO
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Name | DR. SHANNON NOELLE PARKS
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Credential | DO
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Telephone | 207-450-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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