Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | CW0000002 | DE |
NPI | 1154875268 |
---|---|
Provider Name | Shannon Burdeshaw |
First Address | Wilmington, DE 19806-4667 |
Second Address | Wilmington, DE 19806-4667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2016 |
Last Update Date | 05/08/2016 |