Provider Demographics
NPI:1003575622
Name:WARREN, SHAUN LAMONT (NEMT)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:LAMONT
Last Name:WARREN
Suffix:
Gender:M
Credentials:NEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BULKELEY PL APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-4124
Mailing Address - Country:US
Mailing Address - Phone:757-903-9193
Mailing Address - Fax:
Practice Address - Street 1:501 BULKELEY PL APT 1
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-4124
Practice Address - Country:US
Practice Address - Phone:757-903-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60335142172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver