MEDICARE: SHAWNE RENEE BRYANT M.D.

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	174400000X	Specialist	0101038259	VA

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	:	1942203773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNE RENEE BRYANT M.D.

Provider Business Mailing Address
First Line	:	321 EDWIN DR
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4542
Country	:	US
Telephone Number	:	757-671-1112
Fax Number	:	888-276-6619

Provider Business Practice Location Address
First Line	:	321 EDWIN DR
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4542
Country	:	US
Telephone Number	:	757-671-1112
Fax Number	:	888-276-6619

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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