Provider Demographics
NPI:1891715132
Name:SCHELLENBERG, SHANNON ELISABETH (MPA, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ELISABETH
Last Name:SCHELLENBERG
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:ELISABETH
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:1651 N PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4605
Mailing Address - Country:US
Mailing Address - Phone:804-288-8204
Mailing Address - Fax:
Practice Address - Street 1:1651 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4605
Practice Address - Country:US
Practice Address - Phone:804-288-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-002320363AM0700X
VA0110002320363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical