Provider Demographics
NPI:1679356943
Name:BAKER, SHANNON M (RDCS,)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:RDCS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 UNIVERSITY BLVD # 173
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1904
Mailing Address - Country:US
Mailing Address - Phone:407-325-9031
Mailing Address - Fax:
Practice Address - Street 1:720 N MAITLAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8439
Practice Address - Country:US
Practice Address - Phone:407-325-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography