MEDICARE: SHANNON OLIVER I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1184084972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON OLIVER I

Provider Business Mailing Address
First Line	:	10250 N 92ND ST
Second Line	:	SUITE 102
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4510
Country	:	US
Telephone Number	:	480-767-9239
Fax Number	:	480-767-9224

Provider Business Practice Location Address
First Line	:	10250 N 92ND ST
Second Line	:	SUITE 102
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4510
Country	:	US
Telephone Number	:	480-767-9239
Fax Number	:	480-767-9224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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Directions to “ SHANNON OLIVER I ” Practice Location

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