1336428259 NPI number — DR. SHANNON K BIRMINGHAM PSY D

Table of content: DR. SHANNON K BIRMINGHAM PSY D (NPI 1336428259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336428259 NPI number — DR. SHANNON K BIRMINGHAM PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRMINGHAM
Provider First Name:
SHANNON
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336428259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 NORTH COURT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAMPSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13163-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-366-2327
Provider Business Mailing Address Fax Number:
315-366-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 NORTH COURT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMPSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13163-0608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-366-2327
Provider Business Practice Location Address Fax Number:
315-366-2599
Provider Enumeration Date:
08/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com