Provider Demographics
NPI:1689015463
Name:SHOULDIS, LAUREN (DPM)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:SHOULDIS
Suffix:
Gender:
Credentials:DPM
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3720 HOLLAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2859
Mailing Address - Country:US
Mailing Address - Phone:757-498-0202
Mailing Address - Fax:757-498-7936
Practice Address - Street 1:3720 HOLLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2859
Practice Address - Country:US
Practice Address - Phone:757-498-0202
Practice Address - Fax:757-498-7936
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301182213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery