1821362450 NPI number — AUTISM OPPORTUNITIES FOUNDATION

Table of content: MR. MICHAEL BRENDAN SHANNON M.D. (NPI 1538119607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821362450 NPI number — AUTISM OPPORTUNITIES FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTISM OPPORTUNITIES FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1821362450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5860 BAKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55345-5903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-767-4200
Provider Business Mailing Address Fax Number:
952-767-4211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5860 BAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55345-5903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-767-4200
Provider Business Practice Location Address Fax Number:
952-767-4211
Provider Enumeration Date:
02/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WARE
Authorized Official First Name:
RENITA
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
952-767-4200

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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