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 |