Individual
KEVIN SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
(434) 924-3627
Mailing address
710 WALKER SQ APT 3A, CHARLOTTESVILLE, VA 22903-3482
(781) 315-7732
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
VA
Other
Enumeration date
05/18/2026
Last updated
05/18/2026
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