MEDICARE: SHANNON DEEANN DORSEY

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	343900000X	Non-emergency Medical Transport (VAN)	RW446595	OH

General Provider Information

NPI Number	:	1609495654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DEEANN DORSEY

Provider Business Mailing Address
First Line	:	1940 LITCHFIELD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-3810
Country	:	US
Telephone Number	:	937-463-3574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 LITCHFIELD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-3810
Country	:	US
Telephone Number	:	937-463-3574
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/09/2020

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Directions to “ SHANNON DEEANN DORSEY ” Practice Location

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