MEDICARE: SHANNON ELLISON MED

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1255815791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ELLISON MED

Provider Business Mailing Address
First Line	:	3818 169TH ST
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-2138
Country	:	US
Telephone Number	:	317-413-4275
Fax Number	:

Provider Business Practice Location Address
First Line	:	3818 169TH ST
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-2138
Country	:	US
Telephone Number	:	317-413-4275
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

Similar Medicare Providers

1982760096 — UNIQUE HEALTHCARE CORPORATION
Practice Location Address:

3824 169TH ST
COUNTRY CLUB HILLS, IL
60478-2138

Practice Phone: 708-798-9082
Practice Fax: 708-798-9082

1275813024 — BAYAN KADRY PHARMD
Practice Location Address:

263 PINE RIDGE DR
BLOOMFIELD HILLS, MI
48304-2138

Practice Phone: 248-895-9818
Practice Fax:

1740675321 — BIYYIAH LEE BSN
Practice Location Address:

3104 WOODLAND HILLS DR , APT 31
ANN ARBOR, MI
48108-2138

Practice Phone: 773-844-8724
Practice Fax:

1356037162 — CARLY SWARTZ FNP
Practice Location Address:

65 WALNUT ST STE 460
WELLESLEY HILLS, MA
02481-2138

Practice Phone: 781-237-9000
Practice Fax:

1649203571 — JOHN C. L. YU M.D.
Practice Location Address:

1930 COUNTRY PLACE PKWY STE 106
PEARLAND, TX
77584-2138

Practice Phone: 281-506-7840
Practice Fax: 832-672-7485

1295173680 — COMPREHENSIVE CARDIAC DIAGNOSTICS AND WELLNESS PLLC
Practice Location Address:

1930 COUNTRY PLACE PKWY STE 106
PEARLAND, TX
77584-2138

Practice Phone: 281-506-7840
Practice Fax: 832-672-7485

Directions to “ SHANNON ELLISON MED” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.