Provider Demographics
NPI:1427374727
Name:SHELLEY, NEAL HYATT (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:HYATT
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 4TH ST SE
Mailing Address - Street 2:APT 2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2008
Mailing Address - Country:US
Mailing Address - Phone:843-340-1842
Mailing Address - Fax:
Practice Address - Street 1:10306 EATON PL
Practice Address - Street 2:SUITE 180
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2201
Practice Address - Country:US
Practice Address - Phone:703-667-3499
Practice Address - Fax:703-667-3495
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA999999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine