Healthcare Provider Details

I. General information

NPI: 1275502429
Provider Name (Legal Business Name): SHELLEY CRONIN SHORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 ANDERSON HWY STE A
POWHATAN VA
23139-5846
US

IV. Provider business mailing address

3510 ANDERSON HWY STE A
POWHATAN VA
23139-5846
US

V. Phone/Fax

Practice location:
  • Phone: 804-598-3100
  • Fax: 804-556-6526
Mailing address:
  • Phone: 804-598-3100
  • Fax: 804-598-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101052979
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: