Healthcare Provider Details

I. General information

NPI: 1962030643
Provider Name (Legal Business Name): SHEKINAH JOY VAUGHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MOWBRAY ARCH STE 203205
NORFOLK VA
23507
US

IV. Provider business mailing address

3 READING RD
NORTH CHILI NY
14514-9792
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7249
  • Fax:
Mailing address:
  • Phone: 585-889-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101277687
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101277687
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101277687
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: