Healthcare Provider Details

I. General information

NPI: 1164214045
Provider Name (Legal Business Name): SHEHALI RAJAGURU LRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 HICKORY PARK DR STE A
GLEN ALLEN VA
23059-2617
US

IV. Provider business mailing address

5213 HICKORY PARK DR STE A
GLEN ALLEN VA
23059-2617
US

V. Phone/Fax

Practice location:
  • Phone: 877-649-0582
  • Fax: 804-237-8028
Mailing address:
  • Phone: 877-649-0582
  • Fax: 804-237-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019324
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: