Healthcare Provider Details

I. General information

NPI: 1891425377
Provider Name (Legal Business Name): SHELBY MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210A OLD FRANCONIA RD
ALEXANDRIA VA
22310-2529
US

IV. Provider business mailing address

6210A OLD FRANCONIA RD
ALEXANDRIA VA
22310-2529
US

V. Phone/Fax

Practice location:
  • Phone: 540-300-2042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184476
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: