Healthcare Provider Details

I. General information

NPI: 1184550592
Provider Name (Legal Business Name): CASSIDY SHUGRUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 KEMPSVILLE RD STE 221
NORFOLK VA
23502-3820
US

IV. Provider business mailing address

885 KEMPSVILLE RD STE 221
NORFOLK VA
23502-3820
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-0526
  • Fax:
Mailing address:
  • Phone: 757-623-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201002102
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: