Provider Demographics
NPI:1336141910
Name:SHIREY, HUNTER E (PA)
Entity Type:Individual
Prefix:MR
First Name:HUNTER
Middle Name:E
Last Name:SHIREY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:300 MT CLEMENT PARK STE B
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-8670
Practice Address - Fax:804-443-8675
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001333207P00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP33064Medicare UPIN