Healthcare Provider Details

I. General information

NPI: 1912212051
Provider Name (Legal Business Name): MICHELE LEIGH SHIRLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 06/30/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633D MEDICAL GROUP 77 NEALY AVENUE
HAMPTON VA
23665-2040
US

IV. Provider business mailing address

633D MEDICAL GROUP HOSPITAL 77 NEALY AVENUE, BUILDING 257
JOINT BASE LANGLEY-EUSTIS VA
23665-3216
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-2238
  • Fax: 757-225-1807
Mailing address:
  • Phone: 757-225-2238
  • Fax: 757-225-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202207114
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: