Provider Demographics
NPI:1477523066
Name:MCDONNELL, SHANNON M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:MCDONNELL
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 1:111 BULIFANTS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5711
Mailing Address - Country:US
Mailing Address - Phone:757-941-6000
Mailing Address - Fax:757-221-8085
Practice Address - Street 1:100 SENTARA CIRCLE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0429AMedicare PIN