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General NPI Number Information
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NPI Number | 1780176859
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Entity Type | Individual
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Provider Name | SHANNON MEGAN DAVE MD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 2820 NE 214TH ST STE 801
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City | AVENTURA
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State | FL
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Zip | 33180-1269
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 2602 NW LAKE FRONT DR
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City | LAWTON
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State | OK
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Zip | 73505-1252
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Country | US
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Telephone | 888-803-3370
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME160708
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33921
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License Number State | OK
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