Provider Demographics
NPI:1215162524
Name:SHANNON, ANDREW WHITE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WHITE
Last Name:SHANNON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W 8TH ST
Mailing Address - Street 2:BOX C-506
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-4106
Mailing Address - Fax:904-244-5848
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:BOX C-506
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4106
Practice Address - Fax:904-244-5848
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252676207P00000X
LAMD.204123207P00000X
FLME125247207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine