MEDICARE: SHANNON MARKS

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	246Q00000X	Pathology Specialist/Technologist	SLP.0004761	CO
2	246Q00000X	Pathology Specialist/Technologist	SL015059	PA

General Provider Information

NPI Number	:	1760006845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARKS

Provider Business Mailing Address
First Line	:	3500 ROCKMONT DR APT 6103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-2096
Country	:	US
Telephone Number	:	267-885-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 W 13TH AVE APT 213
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80214-4782
Country	:	US
Telephone Number	:	303-770-4682
Fax Number	:

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	05/10/2023

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Directions to “ SHANNON MARKS ” Practice Location

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