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NPI Code Detail

MEDICARE: VICTORIA SHELLY NP

MEDICARE:   VICTORIA  SHELLY  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner0024-035946VA

General Provider Information

NPI Number : 1003888140
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA SHELLY NP
Provider Business Mailing Address
First Line : 5211 MEADOW CREEK DR
Second Line :
City : ROANOKE
State : VA
Zip : 24018-7875
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6415 PETERS CREEK RD
Second Line :
City : ROANOKE
State : VA
Zip : 24019-4021
Country : US
Telephone Number : 540-265-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 04/24/2008

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Directions to “ VICTORIA SHELLY NP” Practice Location

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