Provider Demographics
NPI:1699372060
Name:MEDLEY, SHARI CHISM (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:CHISM
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:
Other - Last Name:CHISM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1153 SALISHAN DR
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3303
Mailing Address - Country:US
Mailing Address - Phone:434-572-7750
Mailing Address - Fax:
Practice Address - Street 1:1088 BAGWELL DR
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:VA
Practice Address - Zip Code:24589-2709
Practice Address - Country:US
Practice Address - Phone:434-476-5131
Practice Address - Fax:434-476-5132
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180189363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health