Individual
SHANNON WHEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-CERTIFIED
Contact information
Practice address
2100 E OCEAN VIEW AVE APT 37, NORFOLK, VA 23518-6103
(678) 755-6308
Mailing address
2100 E OCEAN VIEW AVE APT 37, NORFOLK, VA 23518-6103
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0007247
CO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/28/2019
Last updated
03/09/2022
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