Provider Demographics
NPI:1295770220
Name:DOYAL, SHANNON A (NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:A
Last Name:DOYAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:A
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1026 GOODYEAR AVE
Mailing Address - Street 2:BUILDING 400, SUITE 302
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1102
Mailing Address - Country:US
Mailing Address - Phone:256-492-7246
Mailing Address - Fax:
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:BUILDING 400, SUITE 302
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-492-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096078363LF0000X
GARN132591363LF0000X
AL1096078363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44782Medicare UPIN