Healthcare Provider Details

I. General information

NPI: 1851215453
Provider Name (Legal Business Name): SHEENA BRANNUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 MABE STANLEYTOWN RD
DUFFIELD VA
24244-4645
US

IV. Provider business mailing address

1115 MABE STANLEYTOWN RD
DUFFIELD VA
24244-4645
US

V. Phone/Fax

Practice location:
  • Phone: 276-220-8076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number0001273327
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: