| NPI | 1225491152 |
|---|---|
| Former Name | SHANNON LOUISE DONOVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 66655) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 267966) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 66655) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2021-09-03 |