Provider Demographics
NPI:1285368845
Name:TOWNSEND, SHANNON NICOLE TAYLOR (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NICOLE TAYLOR
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SHANYA CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1547
Mailing Address - Country:US
Mailing Address - Phone:407-394-6897
Mailing Address - Fax:
Practice Address - Street 1:3100 HUNTINGTON AVE BLDG 633
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-3319
Practice Address - Country:US
Practice Address - Phone:757-354-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10281122300000X
VA0401419287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist