Provider Demographics
NPI:1780884593
Name:KNEESEL, SHAWNA MEGAN (MD)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MEGAN
Last Name:KNEESEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 PINTO LN STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4007
Mailing Address - Country:US
Mailing Address - Phone:703-380-7050
Mailing Address - Fax:703-215-9740
Practice Address - Street 1:2011 PINTO LN STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4007
Practice Address - Country:US
Practice Address - Phone:703-380-7050
Practice Address - Fax:703-215-9740
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGM119YMedicare PIN