Domique Shannon, MSW, SUPERVISEE

Primary specialty

Social WorkerTaxonomy code 104100000X

License

0906013267 Issued in VA

Practice address

300 Arboretum PL
Suite 502
North Chesterfield, VA 23236-3473

Phone

(804) 382-8099

NPI assigned

Sep 29, 2023

Sex

Female

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)

Not enrolled

State licenses

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.

• Youth & Family Services of Virginia, Inc.

  • Private Vehicle
  • North Chesterfield, VA
  • NPI 1164887758
  NPD (past)

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1962282848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 ARBORETUM PL STE 502",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363473",
            "telephone_number": "804-887-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 ARBORETUM PL",
            "address_2": "SUITE 502",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363473",
            "telephone_number": "804-382-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "DOMIQUE",
        "credential": "MSW, SUPERVISEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "VA",
            "license": "0906013267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alap Pravin Shah, MD
• Mariyam Shah, DDS
• Saumil R Shah, M.D.
• Vishala Shah
• Seth Shaltes
• Erin Sharkey, DDS
• Sachit Sharma, M.D.
• Sharon Cason Card Consultation
• Gwendolyn Rochelle Sharpeson, LPN
• Amy Lanelle Vondran Shaver, AGACNP

• Social Worker in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.