Provider Demographics
NPI:1316828916
Name:BERG, SHANNON SIMS
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:SIMS
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 AGUA FRIA ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0955
Mailing Address - Country:US
Mailing Address - Phone:505-988-9668
Mailing Address - Fax:
Practice Address - Street 1:1509 AGUA FRIA ST APT 11
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-0955
Practice Address - Country:US
Practice Address - Phone:505-988-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula