Healthcare Provider Details

I. General information

NPI: 1356227151
Provider Name (Legal Business Name): SHELLEY LEANN VALENCIA LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ZINFANDEL RD
WILLIAMSBURG VA
23185-7727
US

IV. Provider business mailing address

100 ZINFANDEL RD
WILLIAMSBURG VA
23185-7727
US

V. Phone/Fax

Practice location:
  • Phone: 504-377-5699
  • Fax:
Mailing address:
  • Phone: 504-377-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606798
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: