Individual
SHAN R FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
118 BROAD ST, DUBLIN, VA 24084-3211
(540) 674-8805
(540) 674-8670
Mailing address
213 S JEFFERSON ST STE 625, ROANOKE, VA 24011-1713
(540) 224-5516
(540) 224-5684
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102204926
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
0102204926
VA
Other
Enumeration date
04/08/2015
Last updated
06/16/2021
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