Healthcare Provider Details

I. General information

NPI: 1376162016
Provider Name (Legal Business Name): ELIZABETH J WILLOUGHBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH J SHEPHEARD

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 W MERCURY BLVD
HAMPTON VA
23666-3115
US

IV. Provider business mailing address

515 NEWTOWN RD
NORFOLK VA
23502
US

V. Phone/Fax

Practice location:
  • Phone: 757-951-1579
  • Fax:
Mailing address:
  • Phone: 757-499-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279770
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: