MEDICARE: SHANNON M ELROD NP

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	363LF0000X	Family Nurse Practitioner	0024180659	VA

General Provider Information

NPI Number	:	1285342329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON M ELROD NP

Provider Business Mailing Address
First Line	:	7919 RIVERSIDE DR
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-4722
Country	:	US
Telephone Number	:	757-617-0954
Fax Number	:

Provider Business Practice Location Address
First Line	:	7547 MEDICAL DR STE 1300
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-4388
Country	:	US
Telephone Number	:	804-695-8550
Fax Number	:	804-695-8554

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	01/11/2026

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