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General NPI Number Information
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NPI Number | 1992928279
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Entity Type | Individual
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Provider Name | SHANNON CASON MCCOY M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 603 E CALL ST
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City | STARKE
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State | FL
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Zip | 32091-3405
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Country | US
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Telephone | 904-964-8900
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Fax | 904-964-5309
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Provider Business Mailing Address
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Address Line | 129 SW DEPOT WAY
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City | FORT WHITE
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State | FL
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Zip | 32038-3442
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Country | US
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Telephone | 386-497-4020
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Fax | 904-964-5309
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 6607
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License Number State | FL
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