Healthcare Provider Details

I. General information

NPI: 1457894511
Provider Name (Legal Business Name): SHAWNI YEAGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 ALVERSER DR
MIDLOTHIAN VA
23113-2653
US

IV. Provider business mailing address

1230 ALVERSER DR
MIDLOTHIAN VA
23113-2653
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-7800
  • Fax:
Mailing address:
  • Phone: 804-893-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020430-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-006996
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: