Healthcare Provider Details

I. General information

NPI: 1477523066
Provider Name (Legal Business Name): SHANNON M MCDONNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SENTARA CIRCLE
WILLIAMSBURG VA
23188-5713
US

IV. Provider business mailing address

111 BULIFANTS BLVD SUITE B
WILLIAMSBURG VA
23188-5711
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-6000
  • Fax:
Mailing address:
  • Phone: 757-941-6000
  • Fax: 757-221-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101232200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: