Provider Demographics
NPI:1497720098
Name:ROSENFELD, SHYAMA (MD)
Entity Type:Individual
Prefix:
First Name:SHYAMA
Middle Name:
Last Name:ROSENFELD
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 1:500 W JUBAL EARLY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6508
Mailing Address - Country:US
Mailing Address - Phone:540-546-2633
Mailing Address - Fax:540-546-2632
Practice Address - Street 1:1440 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3010
Practice Address - Country:US
Practice Address - Phone:540-450-3339
Practice Address - Fax:540-450-3338
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080185748OtherMEDICARE RR
VA5630622Medicaid
VAG55950Medicare UPIN
VA080008129Medicare ID - Type Unspecified