Healthcare Provider Details

I. General information

NPI: 1609730886
Provider Name (Legal Business Name): ANNA MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 TECHNOLOGY DR STE 113B
O FALLON MO
63368-2201
US

IV. Provider business mailing address

19266 COASTAL HWY UNIT 41112
REHOBOTH BEACH DE
19971-6117
US

V. Phone/Fax

Practice location:
  • Phone: 617-693-5767
  • Fax: 866-450-0941
Mailing address:
  • Phone: 617-693-5767
  • Fax: 866-450-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAYNA WALKER
Title or Position: OWNER
Credential: MD
Phone: 617-693-5767