Provider Demographics
NPI:1154331817
Name:SAWIN, SHANNON MULLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MULLIS
Last Name:SAWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9464
Mailing Address - Country:US
Mailing Address - Phone:252-480-1544
Mailing Address - Fax:
Practice Address - Street 1:1123 OCEAN TRAIL
Practice Address - Street 2:
Practice Address - City:COROLLA
Practice Address - State:NC
Practice Address - Zip Code:27927
Practice Address - Country:US
Practice Address - Phone:252-457-0088
Practice Address - Fax:252-457-0159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI0664Medicare UPIN