Individual provider Active NPI

Shannon Marie Lassiter, FNP

  • Family Nurse Practitioner
  • Chesapeake, VA
National Provider Identifier
1053843078
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024174541 Issued in VA
Practice address
2613 Taylor Rd Ste 201
Chesapeake, VA 23321-2246
Phone
(757) 738-1600
Fax
(757) 465-8616
NPI assigned
Mar 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024174541 VA Primary

Addresses

Primary practice location

2613 Taylor Rd Ste 201
Chesapeake, VA 23321-2246

Mailing address

PO Box 639898
Cincinnati, OH 45263-9898

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170608001371 VA Practitioner - Nurse Practitioner 0547538910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Georgetown University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bon Secours Medical Group Hampton Roads Primary Care LLCGroup PAC ID 0941632756, 62 clinicians

Practice addresses (Care Compare)

2613 Taylor Rd
Suite 201
Chesapeake, VA 23321-2246
Phone (757) 738-1600

3537 Airline Blvd
Suite 1
Portsmouth, VA 23701-2650
Phone (757) 738-1225

Hospital & facility affiliations

  • Bon Secours Home Care Home health agency, Suffolk, VA, CCN 497245
  • Bon Secours Maryview Medical Center Hospital, Portsmouth, VA, CCN 490017
  • Bon Secours Harbour View Medical Center Hospital, Suffolk, VA, CCN 490148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024174541VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Hampton Roads Primary Care LLC CurrentSince Mar 5, 2024 Accepting new patients

Locations

2613 Taylor Rd
Ste 201
Chesapeake, VA 23321
Phone (757) 738-1600

155 Kingsley Ln
Ste 150
Norfolk, VA 23505
Phone (757) 278-2350

3537 Airline Blvd
Ste 1
Portsmouth, VA 23701
Phone (757) 738-1225

7185 Harbour Towne Pkwy S
Ste 206
Suffolk, VA 23435
Phone (757) 484-5828

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1053843078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639898",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2613 TAYLOR RD STE 201",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233212246",
            "telephone_number": "757-738-1600",
            "fax_number": "757-465-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASSITER",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-29",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024174541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.