Healthcare Provider Details

I. General information

NPI: 1275593881
Provider Name (Legal Business Name): SHELAGH KATHLEEN GLEESON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6115
  • Fax: 757-275-9998
Mailing address:
  • Phone: 757-388-6115
  • Fax: 757-275-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101244947
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101244947
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0101244947
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101244947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: