Healthcare Provider Details

I. General information

NPI: 1326914144
Provider Name (Legal Business Name): SHANEY MARIE PENBERTHY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

118 MISTY RIDGE LN
SUFFOLK VA
23434-1526
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3000
  • Fax:
Mailing address:
  • Phone: 757-388-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0024195067
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: