Provider Demographics
NPI:1568432706
Name:SHENK, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:SHENK
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:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-0169
Mailing Address - Country:US
Mailing Address - Phone:540-421-0779
Mailing Address - Fax:540-438-0023
Practice Address - Street 1:1046 TULIP TER
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5324
Practice Address - Country:US
Practice Address - Phone:540-421-0779
Practice Address - Fax:540-438-0023
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-038014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3810009499OtherWV MEDICAID
VA42417OtherOPTIMA
VA1000870001OtherDME PROVIDER
VA1568432706Medicaid
VA0802810OtherCIGNA
VA302937OtherANTHEM
VA638339OtherSOUTHERN HEALTH
VA014510R54Medicare PIN
B60045Medicare UPIN