MEDICARE: SHIANNE PFEUFER LMT, MMP

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
1	225700000X	Massage Therapist	0019017787	VA

General Provider Information

NPI Number	:	1528723798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIANNE PFEUFER LMT, MMP

Provider Business Mailing Address
First Line	:	110 BRUMLEY RD
Second Line	:
City	:	KNOTTS ISLAND
State	:	NC
Zip	:	27950
Country	:	US
Telephone Number	:	757-642-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 W GREAT NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1503
Country	:	US
Telephone Number	:	757-642-8960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	11/03/2021

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Directions to “ SHIANNE PFEUFER LMT, MMP” Practice Location

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