Healthcare Provider Details

I. General information

NPI: 1518606946
Provider Name (Legal Business Name): AUSTIN DRENNAN SHANKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

15 HOLLOWAY RD
NEWPORT NEWS VA
23602-7376
US

V. Phone/Fax

Practice location:
  • Phone: 865-405-4683
  • Fax:
Mailing address:
  • Phone: 865-405-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101290172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: