MEDICARE: SHANNON D BURRIS NP

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	363L00000X	Nurse Practitioner	0024134311	VA

General Provider Information

NPI Number	:	1679548705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON D BURRIS NP

Provider Business Mailing Address
First Line	:	28 CHURCH ST
Second Line	:
City	:	MATHEWS
State	:	VA
Zip	:	23109
Country	:	US
Telephone Number	:	804-725-4115
Fax Number	:	804-725-4201

Provider Business Practice Location Address
First Line	:	28 CHURCH ST
Second Line	:
City	:	MATHEWS
State	:	VA
Zip	:	23109
Country	:	US
Telephone Number	:	804-725-4115
Fax Number	:	804-725-4201

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/28/2015

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