Max Shannon, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY61019392 Issued in WA

Practice address

6637 114TH Ave SE
Bellevue, WA 98006-6433

Phone

(503) 766-3690

NPI assigned

Nov 20, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1568836088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6637 114TH AVE SE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980066433",
            "telephone_number": "707-537-5754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6637 114TH AVE SE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980066433",
            "telephone_number": "503-766-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "MAX",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-11-20",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61019392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "max@drmaxshannon.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "508 W Illinois Ave",
            "city": "Ellensburg",
            "state": "WA",
            "country_code": "US",
            "postal_code": "989262481",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "max@drmaxshannon.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "6637 114th Ave SE",
            "city": "Bellevue",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980066433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mitra Shams, L.M.P.
• Darshana Shanbhag, M.D.
• Patricia Angel Shands, M.D.
• Yan Shang
• Marilyn Shannon, PT
• Jeri Lou Shantz, ED.D.
• Qing Shao
• Gabriella Shapiro, MSW
• Alisa Sharma, DC
• Meena Kumari Sharma, PTA

• Clinical Psychologist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.