Provider Demographics
NPI:1508807017
Name:SMITH, SHELLEY CHRISTINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:CHRISTINE
Other - Last Name:SABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 980510
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0510
Mailing Address - Country:US
Mailing Address - Phone:804-828-7208
Mailing Address - Fax:
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:INTERNAL MEDICINE GASTROENTEROLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-7208
Practice Address - Fax:804-828-4945
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166933363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024166933OtherLICENSE FOR N P