| Doctor Name: | DR. SHANNON STOUT |
| NPI Number: | 1932303922 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 0101252227 |
| Business Practice Address: | Psc Box 20080 Ii Marine Expeditionary Force Camp Lejeune, NC - 285420080 |
| Business Phone Number: | 9104518282 |
| Business Fax Number: | |
| Mailing Address: | 3145 Island Dr, N TOPSAIL BEACH |
| State: | NC |
| Postal Code: | 284608178 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/13/2007 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101252227 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |