Provider Demographics
NPI:1346940343
Name:TAYLOR, SHANNON KAY (FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PARK ST SE STE 300
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4653
Mailing Address - Country:US
Mailing Address - Phone:703-255-9100
Mailing Address - Fax:
Practice Address - Street 1:115 PARK ST SE STE 300
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4653
Practice Address - Country:US
Practice Address - Phone:703-255-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily