Provider Demographics
NPI:1720401441
Name:SUFFEL, SHELLIE
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:SUFFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 ETON RD
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-4816
Mailing Address - Country:US
Mailing Address - Phone:540-238-1951
Mailing Address - Fax:
Practice Address - Street 1:2924 ETON RD
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-4816
Practice Address - Country:US
Practice Address - Phone:540-238-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant