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NPI Code Detail

MEDICARE: MRS. SHANNON ELISABETH SCHELLENBERG MPA, PA-C

MEDICARE: MRS. SHANNON ELISABETH SCHELLENBERG MPA, PA-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
1363AM0700XMedical Physician Assistant0110-002320VA
2363AS0400XSurgical Physician Assistant0110002320VA

General Provider Information

NPI Number : 1891715132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON ELISABETH SCHELLENBERG MPA, PA-C
Provider Business Mailing Address
First Line : 1651 N PARHAM RD
Second Line :
City : RICHMOND
State : VA
Zip : 23229-4605
Country : US
Telephone Number : 804-288-8204
Fax Number :
Provider Business Practice Location Address
First Line : 1651 N PARHAM RD
Second Line :
City : RICHMOND
State : VA
Zip : 23229-4605
Country : US
Telephone Number : 804-288-8204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 01/23/2009

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Directions to “ MRS. SHANNON ELISABETH SCHELLENBERG MPA, PA-C” Practice Location

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