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General NPI Number Information
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NPI Number | 1891734372
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Entity Type | Individual
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Provider Name | SHAWN T. BUTELA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 110 KINGSLEY LN SUITE 305
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City | NORFOLK
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State | VA
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Zip | 23505-4614
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Country | US
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Telephone | 757-889-5942
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Fax | 757-889-5422
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Provider Business Mailing Address
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Address Line | 110 KINGSLEY LN SUITE 305
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City | NORFOLK
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State | VA
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Zip | 23505-4614
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Country | US
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Telephone | 757-889-5942
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Fax | 757-889-5422
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A71143
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License Number State | CA
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