MEDICARE: KELLY SHOTTS M.S. SLP

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
1	235Z00000X	Speech-Language Pathologist	2202009539	VA

General Provider Information

NPI Number	:	1093351876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SHOTTS M.S. SLP

Provider Business Mailing Address
First Line	:	412 GOTHAM RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2429
Country	:	US
Telephone Number	:	757-615-2684
Fax Number	:

Provider Business Practice Location Address
First Line	:	4772 EUCLID RD STE C
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3800
Country	:	US
Telephone Number	:	757-615-2684
Fax Number	:	757-540-1126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	11/24/2025

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