Provider Demographics
NPI:1467761833
Name:SHELTON, JENNIFER E (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:STE 8630B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6115
Mailing Address - Fax:757-388-6116
Practice Address - Street 1:1400 CROSSWAYS BLVD STE 114
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0207
Practice Address - Country:US
Practice Address - Phone:757-953-6352
Practice Address - Fax:757-953-6378
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003423363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110003423OtherVA MEDICAL LICENSE