Provider Demographics
NPI:1033526231
Name:SEABROOK, SHENISE (FNP)
Entity Type:Individual
Prefix:
First Name:SHENISE
Middle Name:
Last Name:SEABROOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 STETHEM CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3080
Mailing Address - Country:US
Mailing Address - Phone:843-452-9746
Mailing Address - Fax:
Practice Address - Street 1:6909 STETHEM CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-3080
Practice Address - Country:US
Practice Address - Phone:843-452-9746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176690363LF0000X
SC18891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily