Healthcare Provider Details

I. General information

NPI: 1962240655
Provider Name (Legal Business Name): SHANEEN SILK-VALENTINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 LORTON MARKET ST STE 100
LORTON VA
22079-1965
US

IV. Provider business mailing address

9455 LORTON MARKET ST STE 100
LORTON VA
22079-1965
US

V. Phone/Fax

Practice location:
  • Phone: 703-780-2800
  • Fax:
Mailing address:
  • Phone: 913-558-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83383-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: