Healthcare Provider Details

I. General information

NPI: 1811312465
Provider Name (Legal Business Name): SHELLEY REAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 LASKIN RD
VIRGINIA BEACH VA
23451-6114
US

IV. Provider business mailing address

1800 CAMELOT DR STE 200
VIRGINIA BEACH VA
23454-2440
US

V. Phone/Fax

Practice location:
  • Phone: 757-471-3943
  • Fax:
Mailing address:
  • Phone: 757-252-9600
  • Fax: 757-351-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: