Provider Demographics
NPI:1346252848
Name:BERRY-YATES, SHIRLEY (MED, MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:BERRY-YATES
Suffix:
Gender:F
Credentials:MED, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 SLEEPY HOLLOW RD STE B
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2082
Mailing Address - Country:US
Mailing Address - Phone:703-531-6162
Mailing Address - Fax:
Practice Address - Street 1:2960 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2030
Practice Address - Country:US
Practice Address - Phone:703-531-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178503363LP0808X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor