Healthcare Provider Details

I. General information

NPI: 1528867165
Provider Name (Legal Business Name): SHANNON ZIEGLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GLENN MITCHELL DR
VIRGINIA BEACH VA
23456-0178
US

IV. Provider business mailing address

3848 RIVER OAK CIR
VIRGINIA BEACH VA
23456-8148
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-1123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB202202475
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: