Provider Demographics
NPI:1417024985
Name:SEVERO, SHAUNA MARIE (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:MARIE
Last Name:SEVERO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11409 GREEN MOOR LN
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1240
Mailing Address - Country:US
Mailing Address - Phone:703-860-8811
Mailing Address - Fax:
Practice Address - Street 1:10777 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6903
Practice Address - Country:US
Practice Address - Phone:703-246-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001070406163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator