Doherty, Shannon

Doherty, Shannon is an individual health care provider with primary practice located at 30200 Telegraph Rd Suite 220, Bingham Farms MI 48025-4502. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Doherty, Shannon can be contacted via phone (248) 258-5058.

Contact Information

Primary practice address
30200 Telegraph Rd Suite 220 Bingham Farms MI 48025-4502
Phone: (248) 258-5058
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 4704140193 Michigan

Profile Details

NPI number 1295791580
LBN Legal business name Doherty, Shannon
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2006
Last updated Apr 12th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295791580 NPPES
Michigan MEDICAID 104838402
Michigan Other P00311232

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