Provider Demographics
NPI:1609158260
Name:SHANNON, DELPHINE K (MD)
Entity Type:Individual
Prefix:DR
First Name:DELPHINE
Middle Name:K
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DELPHINE
Other - Middle Name:K
Other - Last Name:VANDERPOOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15429 ONEAL RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2731
Mailing Address - Country:US
Mailing Address - Phone:228-206-0542
Mailing Address - Fax:228-206-0550
Practice Address - Street 1:15429 ONEAL RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2731
Practice Address - Country:US
Practice Address - Phone:228-206-0542
Practice Address - Fax:228-206-0550
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS186682083B0002X, 2088F0040X, 208D00000X, 171400000X, 174H00000X, 202D00000X, 207QB0002X, 207RB0002X, 2080B0002X, 132700000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionist