Healthcare Provider Details

I. General information

NPI: 1750597175
Provider Name (Legal Business Name): SHELLEY MCDONNELL M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 OCEAN SHORE AVE
VIRGINIA BEACH VA
23451-1683
US

IV. Provider business mailing address

3317 OCEAN SHORE AVE
VIRGINIA BEACH VA
23451-1683
US

V. Phone/Fax

Practice location:
  • Phone: 757-232-3179
  • Fax: 855-232-8604
Mailing address:
  • Phone: 757-232-3179
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005039
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: