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General NPI Number Information
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NPI Number | 1609158260
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Entity Type | Individual
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Provider Name | DELPHINE K. SHANNON M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 15429 ONEAL RD
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City | GULFPORT
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State | MS
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Zip | 39503-2731
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Country | US
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Telephone | 228-206-0542
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Fax | 228-206-0550
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Provider Business Mailing Address
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Address Line | 15429 ONEAL RD
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City | GULFPORT
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State | MS
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Zip | 39503-2731
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Country | US
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Telephone | 228-206-0542
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Fax | 228-206-0550
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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 | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 18668
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 18668
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License Number State | MS
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Taxonomy #6
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #7
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #8
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #9
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Taxonomy Code | 2080B0002X
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Taxonomy Name | Pediatric Obesity Medicine Physician
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License Number | 18668
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License Number State | MS
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Taxonomy #10
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number | 18668
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License Number State | MS
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Taxonomy #11
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 18668
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License Number State | MS
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