Healthcare Provider Details

I. General information

NPI: 1336315167
Provider Name (Legal Business Name): SHELLY-ANN JAMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 FAIR LAKES PKWY
FAIRFAX VA
22033-3952
US

IV. Provider business mailing address

111 COLLEGE RD APT 4F
SELDEN NY
11784-2800
US

V. Phone/Fax

Practice location:
  • Phone: 540-720-7340
  • Fax:
Mailing address:
  • Phone: 631-946-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101248442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: