Provider Demographics
NPI:1275502429
Name:SHORT, SHELLEY CRONIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:CRONIN
Last Name:SHORT
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 1:3510 ANDERSON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5846
Mailing Address - Country:US
Mailing Address - Phone:804-598-3100
Mailing Address - Fax:804-598-2965
Practice Address - Street 1:3510 ANDERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5846
Practice Address - Country:US
Practice Address - Phone:804-598-3100
Practice Address - Fax:804-556-6526
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275502429Medicaid
VA005628105Medicaid
VA112758OtherBCBS(ANTHEM)
VA112758OtherBCBS(ANTHEM)
VA080006297Medicare ID - Type Unspecified
VA005628105Medicaid
VAG27417Medicare UPIN
VABS5500524OtherDEA
VAVV4340AMedicare PIN