Provider Demographics
NPI:1316033319
Name:MILLER, KENLYN SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENLYN
Middle Name:SHAWN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 MEDICAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3437
Mailing Address - Country:US
Mailing Address - Phone:540-433-2485
Mailing Address - Fax:540-433-2010
Practice Address - Street 1:1921 MEDICAL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3437
Practice Address - Country:US
Practice Address - Phone:540-433-2485
Practice Address - Fax:540-433-2010
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057573207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6302297Medicaid
VA180000876Medicare ID - Type Unspecified
VA6302297Medicaid