MEDICARE: SHANNON SIMS BERG

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	374J00000X	Doula

General Provider Information

NPI Number	:	1316828916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SIMS BERG

Provider Business Mailing Address
First Line	:	1509 AGUA FRIA ST APT 11
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-0955
Country	:	US
Telephone Number	:	505-988-9668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 AGUA FRIA ST APT 11
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-0955
Country	:	US
Telephone Number	:	505-988-9668
Fax Number	:

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

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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Directions to “ SHANNON SIMS BERG ” Practice Location

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