Individual
SHANNON BAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPEECH/LANG PATH
Contact information
Practice address
600 JACKSON ST, FREDERICKSBURG, VA 22401
(540) 373-3223
Mailing address
3422 LANCASTER RING ROAD, FREDERICKSBURG, VA 22408
(540) 710-5706
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202003993
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036802
SENTARA
VA
01
—
192571
ANTHEM HEALTHKEEP
VA
01
—
243017
MDIPA
VA
Enumeration date
10/04/2006
Last updated
07/09/2007
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