Provider Demographics
NPI:1649044181
Name:MEDARIS, SHANNON LEIGH (DNP-FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:MEDARIS
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 LEISURE WAY
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4169
Mailing Address - Country:US
Mailing Address - Phone:304-886-8330
Mailing Address - Fax:
Practice Address - Street 1:318 LEISURE WAY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4169
Practice Address - Country:US
Practice Address - Phone:304-886-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program