Shannan Rae Dahl, RN, MT

Primary specialty

Critical Care Medicine Registered NurseTaxonomy code 163WC0200X

License

0001298714 Issued in VA

Practice address

13801 Braddock Springs Rd Apt K
Centreville, VA 20121-4245

Phone

(703) 853-3351

NPI assigned

Dec 31, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician, Registered Nurse

State licenses

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

{
    "created_epoch": "1640908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640908800000",
    "number": "1154082212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 893",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201560893",
            "telephone_number": "703-853-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13801 BRADDOCK SPRINGS RD APT K",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201214245",
            "telephone_number": "703-853-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHL",
        "first_name": "SHANNAN",
        "middle_name": "RAE",
        "credential": "RN, MT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-31",
        "last_updated": "2021-12-31",
        "certification_date": "2021-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "VA",
            "license": "0019011674",
            "primary": false
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "VA",
            "license": "0001298714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cyril Joseph MDPC
• Brandon Anthony Czekaj, D.C.
• Rohit Dasgupta, MD
• Lenore L Day, M.D.
• Jacqueline Arnold De Conti, DPT
• Debra L. Tievsky, LCSW, PC
• Joseph Deleon, NCBTMB, OMT, CMRMP

• Critical Care Medicine Registered Nurse in Centreville, VA
• Providers in Centreville, VA by specialty
• Critical Care Medicine Registered Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.