Individual provider · Type 1 NPI

Frederick Shannon

Student in an Organized Health Care Education/Training Program · Portland, OR

NPI number 1245168657 Active

Practice location

2130 SW Jefferson St Ste 200
Portland, OR 97201-7710

Call (971) 266-6910 Map

Mailing address

5541 SE Henderson St
Portland, OR 97206-8232

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XA824721 (OR)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1245168657

Frederick Shannon's National Provider Identifier is 1245168657, issued on May 13, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Portland, OR. The record was last updated on May 13, 2026.