Provider Demographics
NPI:1053743286
Name:SHAWN MARSH, SAMANTHA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SHAWN MARSH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2415
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-2415
Mailing Address - Country:US
Mailing Address - Phone:804-302-8164
Mailing Address - Fax:804-302-8165
Practice Address - Street 1:137 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-7101
Practice Address - Country:US
Practice Address - Phone:043-028-1648
Practice Address - Fax:804-302-8165
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171029363LP0808X
RIAPRN01712363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health