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General NPI Number Information
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NPI Number | 1942203773
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Entity Type | Individual
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Provider Name | SHAWNE RENEE BRYANT M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 321 EDWIN DR STE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-4542
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Country | US
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Telephone | 757-671-1112
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Fax | 888-276-6619
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Provider Business Mailing Address
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Address Line | 321 EDWIN DR STE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-4542
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Country | US
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Telephone | 757-671-1112
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Fax | 888-276-6619
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101038259
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License Number State | VA
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