Healthcare Provider Details

I. General information

NPI: 1932882099
Provider Name (Legal Business Name): SHARI FENNEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3105 AMERICAN LEGION RD STE A
CHESAPEAKE VA
23321-5653
US

IV. Provider business mailing address

3105 AMERICAN LEGION RD STE A
CHESAPEAKE VA
23321-5653
US

V. Phone/Fax

Practice location:
  • Phone: 757-575-1482
  • Fax: 757-282-2421
Mailing address:
  • Phone: 757-575-1482
  • Fax: 757-282-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: