Individual
ARDIS CHRISTOPHER SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4522 MARLIN AVE, SUFFOLK, VA 23435-2377
(757) 641-1876
Mailing address
4522 MARLIN AVENUE, SUFFOLK, VA, USA, SUFFOLK, VA 23435-2377
(757) 641-1876
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
243944436
MS
343800000X
Secured Medical Transport (VAN)
243944436
MS
343900000X
Non-emergency Medical Transport (VAN)
243944436
MS
Other
Enumeration date
01/24/2024
Last updated
02/22/2024
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