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General NPI Number Information
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NPI Number | 1669359303
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Entity Type | Individual
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Provider Name | SOFIA SHANNON
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 200 TUCKERTON RD
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City | MEDFORD
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State | NJ
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Zip | 08055-8806
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Country | US
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Telephone | 856-347-3464
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Fax |
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Provider Business Mailing Address
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Address Line | 206 POPLAR AVE
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City | EVESHAM
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State | NJ
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Zip | 08053-7136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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