Healthcare Provider Details

I. General information

NPI: 1427474840
Provider Name (Legal Business Name): SHANLEY BANAAG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANLEY IGNACIO D.O.

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6251 E VIRGINIA BEACH BLVD STE 200
NORFOLK VA
23502-2800
US

IV. Provider business mailing address

6350 CENTER DR STE 200
NORFOLK VA
23502-4107
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-8683
  • Fax: 757-466-8892
Mailing address:
  • Phone: 757-905-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2025-00579
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0102204539
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: