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NPI Code Detail

MEDICARE: SHADESIA NICHOLSON FNP-C

MEDICARE: SHADESIA NICHOLSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0024183858VA

General Provider Information

NPI Number : 1043967284
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHADESIA NICHOLSON FNP-C
Provider Business Mailing Address
First Line : 1181 FIRST COLONIAL RD STE 200
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-2437
Country : US
Telephone Number : 757-425-1600
Fax Number :
Provider Business Practice Location Address
First Line : 1181 FIRST COLONIAL RD STE 200
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-2437
Country : US
Telephone Number : 757-425-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2022
Last Update Date : 03/26/2026

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Directions to “ SHADESIA NICHOLSON FNP-C” Practice Location

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