Provider Demographics
NPI:1518550359
Name:BROWN, SHELLY M (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 RUTHS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23030-2225
Mailing Address - Country:US
Mailing Address - Phone:804-252-0793
Mailing Address - Fax:
Practice Address - Street 1:5061 RUTHS CT
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:VA
Practice Address - Zip Code:23030-2225
Practice Address - Country:US
Practice Address - Phone:804-252-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily