Healthcare Provider Details

I. General information

NPI: 1356240923
Provider Name (Legal Business Name): SHANNON DUNCAN MCCLURE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 FLOYD HWY S
WILLIS VA
24380-4021
US

IV. Provider business mailing address

6733 FLOYD HWY S
WILLIS VA
24380-4021
US

V. Phone/Fax

Practice location:
  • Phone: 540-790-7903
  • Fax: 540-790-7903
Mailing address:
  • Phone: 540-790-7903
  • Fax: 540-790-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0735001748
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: