Individual
SHAWN JAMES MENDONCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2296 OPITZ BLVD STE 350, WOODBRIDGE, VA 22191-3346
(703) 680-2111
(703) 878-3939
Mailing address
2296 OPITZ BLVD STE 350, WOODBRIDGE, VA 22191-3346
(703) 680-2111
(703) 878-3939
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101280217
VA
208800000X
Urology Physician
297137
NY
208800000X
Urology Physician
MD471068
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
297137
LICENSE
NY
Enumeration date
03/24/2013
Last updated
04/25/2024
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