Provider Demographics
NPI:1033188586
Name:HOOVER, SHELLEY KAE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:KAE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4210
Mailing Address - Country:US
Mailing Address - Phone:804-264-4262
Mailing Address - Fax:804-264-4260
Practice Address - Street 1:7813 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4210
Practice Address - Country:US
Practice Address - Phone:804-264-4262
Practice Address - Fax:804-264-4260
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-053613207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V192S98Medicare ID - Type Unspecified
VAG65206Medicare UPIN