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General NPI Number Information
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NPI Number | 1417744103
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Entity Type | Individual
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Provider Name | SHANNON M WALKER CCMA
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Gender | Female
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 100 7TH ST STE 104
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City | PORTSMOUTH
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State | VA
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Zip | 23704-4800
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Country | US
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Telephone | 757-330-5248
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Fax | 757-330-5290
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Provider Business Mailing Address
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Address Line | 100 7TH ST STE 104
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City | PORTSMOUTH
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State | VA
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Zip | 23704-4800
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Country | US
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Telephone | 757-330-5248
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Fax | 757-330-5290
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number | CCMA-2262
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License Number State | VA
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