MEDICARE: DR. SHANNA AMANDA JEFFERSON MSW,CFSW,LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C008185	NC
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093012031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNA AMANDA JEFFERSON MSW,CFSW,LCSW

Provider Business Mailing Address
First Line	:	2530 MERIDIAN PKWY STE 300
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5273
Country	:	US
Telephone Number	:	919-794-5284
Fax Number	:	866-923-0754

Provider Business Practice Location Address
First Line	:	2530 MERIDIAN PKWY STE 300
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5273
Country	:	US
Telephone Number	:	919-794-5284
Fax Number	:	866-923-0754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/11/2026

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