MEDICARE: VITALITY GYNECOLOGY, LLC

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
1	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1619827920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY GYNECOLOGY, LLC

Provider Business Mailing Address
First Line	:	1446 KEMPSVILLE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7300
Country	:	US
Telephone Number	:	757-381-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1446 KEMPSVILLE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7300
Country	:	US
Telephone Number	:	757-381-4969
Fax Number	:

Authorized Official
Title or Position	:	WHNP
Name	:	LINSEY SHREVE
Credential	:	DNP, WHNP-BC, CST
Telephone Number	:	757-381-4969

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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