Provider Demographics
NPI:1922052810
Name:DAVIS, SHANNON P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANE
Other - Middle Name:P
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:201 WHITESPORT DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6449
Mailing Address - Country:US
Mailing Address - Phone:256-881-5353
Mailing Address - Fax:256-881-0712
Practice Address - Street 1:201 WHITESPORT DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6449
Practice Address - Country:US
Practice Address - Phone:256-881-5353
Practice Address - Fax:256-881-0712
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23766207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007399267OtherAETNA
ALH20531Medicare UPIN