Provider Demographics
NPI:1861143372
Name:SWABY, SHANNON THALIA
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:THALIA
Last Name:SWABY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3938
Mailing Address - Country:US
Mailing Address - Phone:860-752-8463
Mailing Address - Fax:
Practice Address - Street 1:81 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3938
Practice Address - Country:US
Practice Address - Phone:860-752-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider