Provider Demographics
NPI:1821699968
Name:SHIN, MICHELLE MIHEE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MIHEE
Last Name:SHIN
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 1:6200 LITTLE RIVER TPKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1700
Mailing Address - Country:US
Mailing Address - Phone:703-370-0122
Mailing Address - Fax:
Practice Address - Street 1:6200 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1700
Practice Address - Country:US
Practice Address - Phone:703-370-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist