Healthcare Provider Details

I. General information

NPI: 1265535710
Provider Name (Legal Business Name): SHEILA A TETREAULT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. SHEILA A SHRANATAN

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FETTLER PARK DR
DUMFRIES VA
22025-2050
US

IV. Provider business mailing address

9300 DEWITT LOOP RM 218
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 703-441-7604
  • Fax:
Mailing address:
  • Phone: 571-231-2891
  • Fax: 571-231-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberH0062598
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0062598
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: