Shannon Monique Medina

NPI #1366092645 in Penasco, New Mexico

Provider Information

NPI Number: 1366092645
Entity Type: Individual
Name: Shannon Monique Medina
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Enumeration Date: Sep 18, 2019
Last Updated: Sep 18, 2019

Practice Location

Address: 13 OLD SCHOOL RD
City: Penasco
State: New Mexico
ZIP Code: 87553
Phone: (575) 587-2502

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - School — School	1041S0200X
Social Worker	104100000X	Primary

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