Healthcare Provider Details

I. General information

NPI: 1285342329
Provider Name (Legal Business Name): SHANNON M ELROD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 01/11/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 MEDICAL DR STE 1300
GLOUCESTER VA
23061-4388
US

IV. Provider business mailing address

7919 RIVERSIDE DR
GLOUCESTER VA
23061-4722
US

V. Phone/Fax

Practice location:
  • Phone: 804-695-8550
  • Fax: 804-695-8554
Mailing address:
  • Phone: 757-617-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: