MEDICARE: DR. SHANNEN M MCGINLEY-VALLEE DO

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	208000000X	Pediatrics Physician	OS18776	FL

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	:	1154884815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNEN M MCGINLEY-VALLEE DO

Provider Business Mailing Address
First Line	:	134 S WOODS DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-3262
Country	:	US
Telephone Number	:	321-636-3066
Fax Number	:	321-636-2545

Provider Business Practice Location Address
First Line	:	8057 SPYGLASS HILL RD STE 102
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-8565
Country	:	US
Telephone Number	:	321-435-9800
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	07/20/2022

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