Healthcare Provider Details

I. General information

NPI: 1750019071
Provider Name (Legal Business Name): SHANNON MASSE SCHOENFELD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CHEROKEE PROFESSIONAL PARK
MARYVILLE TN
37804-5153
US

IV. Provider business mailing address

PO BOX 5777
MARYVILLE TN
37802-5777
US

V. Phone/Fax

Practice location:
  • Phone: 865-980-5200
  • Fax: 865-980-5201
Mailing address:
  • Phone: 865-246-2104
  • Fax: 865-246-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32074
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: