| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SHANNON FIODOROVAS | 1972186500 | 2021-05-02 |
Shannon Fiodorovas is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1972186500. Registration indicates Shannon Fiodorovas is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Shannon Fiodorovas |
| Practice Office Address | 3836 LESIA DR WARREN, MI US |
| Practice Office Telephone | 7347703420 |
| Mailing Address | 3836 LESIA DR WARREN, MI 480916515 US |
| Business Telephone | 7347703420 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |