Walter Daniel Shannon Jr., M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

200301170 Issued in NC

Practice address

1305 North Queen Street
Kinston, NC 28501-1581

Phone

(252) 523-2781

Fax

(252) 523-2711

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Alternative Care Treatments Systems, Inc

  • Community/Behavioral Health Agency
  • Goldsboro, NC
  • NPI 1558487421
  NPD (past)
• Eastpointe Human Services

  • Community/Behavioral Health Agency
  • Lumberton, NC
  • NPI 1306058524
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255910400000",
    "number": "1508875394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 NORTH QUEEN STREET",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285011581",
            "telephone_number": "252-523-2781",
            "fax_number": "252-523-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 NORTH QUEEN STREET",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285011581",
            "telephone_number": "252-523-2781",
            "fax_number": "252-523-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "WALTER",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2009-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "200301170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charity B Sellers, NP
• Kelly Marie Semon
• Jamie Lynn Benedek Serrano, D.O.
• Kia Sewell-Chance, M.D.
• Jessica Theobald Seymour, NUTRITIONIST
• SHC Medical Partners of North Carolina, LLC
• Jennifer M Shenk, O.D.
• Shipman Family Home Care Inc.
• Ajai Shreevatsa, MD
• Michael Shutak II, PA-C

• Psychiatry Physician in Kinston, NC
• Providers in Kinston, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; 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.