Provider Demographics
NPI:1033641006
Name:RANKIN, SHELLIE LINDBERGH JR
Entity Type:Individual
Prefix:MR
First Name:SHELLIE
Middle Name:LINDBERGH
Last Name:RANKIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 NEWBY RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3130
Mailing Address - Country:US
Mailing Address - Phone:757-349-3451
Mailing Address - Fax:
Practice Address - Street 1:1402 NEWBY RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3130
Practice Address - Country:US
Practice Address - Phone:757-349-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health