Provider Demographics
NPI:1952367195
Name:SHOCKLEY, NADIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:C
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NADIA
Other - Middle Name:C
Other - Last Name:SLYSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12690 MCMANUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4433
Mailing Address - Country:US
Mailing Address - Phone:757-875-7700
Mailing Address - Fax:757-875-7721
Practice Address - Street 1:12690 MCMANUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4433
Practice Address - Country:US
Practice Address - Phone:757-875-7700
Practice Address - Fax:757-875-7721
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28682207W00000X
VA0101243667207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ532631Medicaid
H27564Medicare UPIN
VAC09593Medicare PIN
AZ180042848Medicare PIN
VAMC10933Medicare UPIN
AZZ66496Medicare PIN