Provider Demographics
NPI:1174594261
Name:PERRY, SHAWNA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:JANE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-612-8154
Practice Address - Fax:757-594-2196
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101243586207P00000X
FLME60708207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000645455AMedicaid
FL3741753-01Medicaid
FL930028199OtherRAILROAD MEDICARE
FL930028199OtherRAILROAD MEDICARE
FLS42136Medicare UPIN