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NPI Code Detail

MEDICARE: SHANNON GRAHAM

MEDICARE: SHANNON GRAHAM
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
1363LF0000XFamily Nurse PractitionerAPRN.CNP.0033802OH

General Provider Information

NPI Number : 1376328583
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON GRAHAM
Provider Business Mailing Address
First Line : 8701 TROY PIKE STE 20
Second Line :
City : DAYTON
State : OH
Zip : 45424-1073
Country : US
Telephone Number : 937-237-9254
Fax Number :
Provider Business Practice Location Address
First Line : 8701 TROY PIKE STE 20
Second Line :
City : DAYTON
State : OH
Zip : 45424-1073
Country : US
Telephone Number : 937-237-9254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 02/13/2026

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