Healthcare Provider Details

I. General information

NPI: 1588359210
Provider Name (Legal Business Name): SHANNON LEIGH DUMMER DNP, FNP, CEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LEIGH O'CONNOR

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1352 WALNUT AVE
ANNAPOLIS MD
21403-4748
US

IV. Provider business mailing address

1352 WALNUT AVE
ANNAPOLIS MD
21403-4748
US

V. Phone/Fax

Practice location:
  • Phone: 443-221-8716
  • Fax: 949-437-8515
Mailing address:
  • Phone: 443-221-8716
  • Fax: 949-437-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR246089
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: