MEDICARE: SHAWNA C WILLEY MD

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	2086X0206X	Surgical Oncology Physician	14296	DC
2	2086X0206X	Surgical Oncology Physician	0101042052	VA

General Provider Information

NPI Number	:	1619976792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA C WILLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	8081 INNOVATION PARK DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4867
Country	:	US
Telephone Number	:	571-472-4724
Fax Number	:	571-472-0241

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/15/2022

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Directions to “ SHAWNA C WILLEY MD” Practice Location

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