Provider Demographics
NPI:1386075471
Name:HANBERRY, DAVID SHAWN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SHAWN
Last Name:HANBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-2204
Mailing Address - Country:US
Mailing Address - Phone:757-771-9548
Mailing Address - Fax:757-868-6527
Practice Address - Street 1:128 CHURCH RD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-2204
Practice Address - Country:US
Practice Address - Phone:757-771-9548
Practice Address - Fax:757-868-6527
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA46-4181838OtherFEIN