Healthcare Provider Details

I. General information

NPI: 1720059835
Provider Name (Legal Business Name): SHANNON GIOVINAZZO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13616 NUBIAN CT
HERNDON VA
20171-4101
US

IV. Provider business mailing address

13616 NUBIAN CT
HERNDON VA
20171-4101
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-2639
  • Fax: 301-295-6969
Mailing address:
  • Phone: 301-295-2639
  • Fax: 301-295-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001091654
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: