Provider Demographics
NPI:1669229472
Name:GARAY, SHANNON THERESA (BSN, RNC, CNM/WHNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:THERESA
Last Name:GARAY
Suffix:
Gender:F
Credentials:BSN, RNC, CNM/WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 KALARIS PL SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5140
Mailing Address - Country:US
Mailing Address - Phone:205-873-2405
Mailing Address - Fax:
Practice Address - Street 1:1027 KALARIS PL SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-5140
Practice Address - Country:US
Practice Address - Phone:205-873-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192145367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife