Healthcare Provider Details

I. General information

NPI: 1194796250
Provider Name (Legal Business Name): SHANNON M DAWSON-RICHARDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

8348 ARGENT CIR
FAIRFAX STATION VA
22039-3104
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax: 703-490-7635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: