Provider Demographics
NPI:1003020660
Name:TIERNEY, SHANNON N (MD, MS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:T
Other - Last Name:MCELEARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:70 MEDICAL CENTER CIR STE 107&213
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-245-7705
Practice Address - Fax:540-245-7710
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2495432086X0206X
WAMD60090634208600000X
VA0116014011390200000X
VA0101267589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1003020660Medicaid