| NPI | 1538370630 |
|---|---|
| Former Name | SHANNON ELIZABETH DODGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: NY 246215) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY) |
| 208000000X Pediatrics (Licence: NY 246215) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2015-04-23 |