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NPI Code Detail

MEDICARE: STEPHANIE SHAMMA APRN, MSN FNP-BC.

MEDICARE: STEPHANIE SHAMMA APRN, MSN FNP-BC.
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
1363LF0000XFamily Nurse Practitioner104520WV

General Provider Information

NPI Number : 1629690037
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE SHAMMA APRN, MSN FNP-BC.
Provider Business Mailing Address
First Line : 404 BUCKINGHAM POINTE
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-8270
Country : US
Telephone Number : 304-415-1147
Fax Number :
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1398
Country : US
Telephone Number : 304-766-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2020
Last Update Date : 09/23/2024

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