Healthcare Provider Details

I. General information

NPI: 1659913143
Provider Name (Legal Business Name): SHANNON JIHYE HWANG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 LITTLE RIVER TPKE STE 201
ANNANDALE VA
22003-3546
US

IV. Provider business mailing address

6715 LITTLE RIVER TPKE STE 201
ANNANDALE VA
22003-3546
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-5568
  • Fax: 703-299-1794
Mailing address:
  • Phone: 703-535-5568
  • Fax: 703-299-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178530
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001242479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: