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NPI Code Detail

MEDICARE: SHANNON D MCQUEEN MD

MEDICARE: SHANNON D MCQUEEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician9501229NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
129428OTHERNCBCBS

General Provider Information

NPI Number : 1255336632
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON D MCQUEEN MD
Provider Business Mailing Address
First Line : 301 E WENDOVER AVE STE 400
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1207
Country : US
Telephone Number : 336-832-3150
Fax Number : 336-832-3151
Provider Business Practice Location Address
First Line : 301 E WENDOVER AVE STE 400
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1207
Country : US
Telephone Number : 336-832-3150
Fax Number : 336-832-3151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 08/18/2021

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Directions to “ SHANNON D MCQUEEN MD” Practice Location

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