MEDICARE: SHAUN M REYNOLDS M.D.

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	207P00000X	Emergency Medicine Physician	01076107A	IN
2	207P00000X	Emergency Medicine Physician	0101261779	VA
3	207P00000X	Emergency Medicine Physician	47305	KY

General Provider Information

NPI Number	:	1821383944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN M REYNOLDS M.D.

Provider Business Mailing Address
First Line	:	6141 SYLVAN ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-1033
Country	:	US
Telephone Number	:	502-852-5689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 COLISEUM DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23666
Country	:	US
Telephone Number	:	502-852-5689
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	03/12/2021

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Directions to “ SHAUN M REYNOLDS M.D.” Practice Location

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