SHANNON MARIE WAGNER (NPI# 1538780077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538780077 |
| Entity Type | Individual |
| Full Name | SHANNON MARIE WAGNER |
| Credential | LCSW |
| Practice Address |
2310 E Atlantic Blvd Bldg 2 Pompano Beach FL 33062-5251 |
| Practice Telephone | 9549907171 |
| Practice Fax Number | 9545305992 |
| Mailing Telephone | 9549907171 |
| Mailing Fax Number | 9545305992 |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-05-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
SW16190 | FL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225686538 | Shannon Lee Wagner | Behavior Technician | 203 Union St, Manchester, CT 06042-1938 | 2019-08-29 |
| 1255956512 | Shannon Michelle Wagner | Registered Nurse | 551 Broadway, Eagle, CO 81631 | 2020-06-12 |
| 1265073324 | Shannon Dee Wagner | Case Manager/Care Coordinator | 185 N 4th St, Saint Helens, OR 97051-1535 | 2019-09-30 |
| 1427512854 | Shannon Wagner | Behavior Technician | 613 Stephenson Ave Ste 206, Savannah, GA 31405-5841 | 2019-01-30 |
| 1437624079 | Shannon Wagner | Behavior Technician | 901 Caledonia St, La Crosse, WI 54603-2616 | 2018-10-10 |
| 1871832691 | Shannon Wagner | Speech-Language Pathologist | 125 Ryan Industrial Ct, San Ramon, CA 94583-1772 | 2013-02-14 |
| 1467590737 | Shannon Wagner | Community/Behavioral Health | 2086 Commerce Ave, Concord, CA 94520-4902 | 2007-02-01 |
| Street Address |
2310 E ATLANTIC BLVD BLDG 2 |
| City | POMPANO BEACH |
| State | FL |
| Zip Code | 33062-5251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265961 | Publix Super Markets, Inc | Durable Medical Equipment & Medical Supplies | 555 Channelside Dr, Tampa, FL 33062 | 2020-11-03 |
| 1396351821 | Brittney Eluett | Social Worker | 2637 E. Atlantic Blvd., Suite 38267, Pompano Beach, FL 33062 | 2020-09-21 |
| 1124537634 | Aaron Gabriel Grossman | General Practice | 2637 E Atlantic Blvd # 38598, Pompano Beach, FL 33062 | 2017-09-27 |
| 1790215309 | Daylis Perez-borroto Rodriguez | Dentist | 950 N Federal Hwy Suite 202, Pompano Beach, FL 33062 | 2017-06-15 |
| 1235686783 | Ican Benefit Group | Supports Brokerage | 2251 North Federal Highway, Pompano Beach, FL 33062 | 2016-09-01 |
| 1336503689 | Adriana Diaz Backer | Dentist | 2707 E. Atlantic Blvd, Pompano Beach, FL 33062 | 2016-04-12 |
| 1255723367 | Pierre G Lazore | Acupuncturist | 2637 E Atlantic Blvd # 119, Pompano Beach, FL 33062 | 2015-02-26 |
| 1467870386 | Visionworks, Inc | Eyewear Supplier (Equipment, not the service) | 2471 North Federal Highway, Pompano Beach, FL 33062 | 2014-03-29 |
| 1598192460 | Banyan Treatment and Recovery, LLC | Clinic/Center | 950 N. Federal Hwy, Suite 115, Pompano Beach, FL 33062 | 2013-10-08 |
| 1578905840 | Edwin C Delz | Dentist | 2323 Ne 26 Ave, Pompano Beach, FL 33062 | 2013-07-26 |
| Find all providers in zip 33062 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528697232 | Sachi Ananda LLC | Counselor | 111 Briny Ave Apt 2605, Pompano Beach, FL 33062-5669 | 2020-04-04 |
| 1003337676 | Mary Nelms | Counselor | 2832 Ne 13th Ave, Pompano Beach, FL 33064-6805 | 2017-07-04 |
| 1902254006 | Stuart Lyle Azoulay | Counselor | 1510 Sw 4th Ave, Pompano Beach, FL 33060-9002 | 2016-05-31 |
| 1811353568 | Denisse Knorr | Counselor | 137 Ne 7th St, Pompano Beach, FL 33060-6133 | 2016-01-11 |
| 1205245958 | Anthony Smith | Counselor | 4120 Ne 2nd Ave, Pompano Beach, FL 33064-3508 | 2014-08-07 |
| 1194155465 | Dione Massicot De Pooter | Counselor | 2300 W Sample Rd, Suite 102, Pompano Beach, FL 33073-3080 | 2013-11-22 |
| 1649562562 | Laura E. Booth | Counselor | 5131 Ne 19th Ter, Pompano Beach, FL 33064-5635 | 2011-05-11 |
| 1871720144 | Tamela J Stull- Drugan | Counselor | 100 E Sample Rd Ste 200, Pompano Beach, FL 33064-3554 | 2009-06-15 |
| 1831676477 | Dean Omowale Sababu | Counselor | 380 Sw 12th Ave, Pompano Beach, FL 33069-3502 | 2018-07-26 |
| 1942798038 | Francisca Gilene Millet | Counselor | 380 Sw 12th Ave, Pompano Beach, FL 33069-3502 | 2018-04-25 |
| Find all providers in POMPANO BEACH | ||||
| City | POMPANO BEACH |
| Zip Code | 33062 |
Please comment or provide details below to improve the information on SHANNON MARIE WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.