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General NPI Number Information
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NPI Number | 1427474840
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Entity Type | Individual
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Provider Name | SHANLEY BANAAG D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 6251 E VIRGINIA BEACH BLVD STE 200
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City | NORFOLK
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State | VA
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Zip | 23502-2800
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Country | US
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Telephone | 757-466-8683
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Fax | 757-466-8892
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Provider Business Mailing Address
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Address Line | 6350 CENTER DR STE 200
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City | NORFOLK
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State | VA
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Zip | 23502-4107
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Country | US
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Telephone | 757-905-5558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 2025-00579
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 0102204539
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License Number State | VA
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