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General NPI Number Information
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NPI Number | 1942854302
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Entity Type | Individual
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Provider Name | SHANNON SABANOSH
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 2501 PARKERS LN
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3209
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Country | US
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Telephone | 703-664-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 43796 MAISON BLANC SQ
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City | ASHBURN
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State | VA
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Zip | 20148-3100
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AC006412
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP500009754
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0001236550
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License Number State | VA
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