1912212051 NPI number — MICHELE LEIGH SHIRLEY PHARMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912212051 NPI number — MICHELE LEIGH SHIRLEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIRLEY
Provider First Name:
MICHELE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912212051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633D MEDICAL GROUP HOSPITAL
Provider Second Line Business Mailing Address:
77 NEALY AVENUE, BUILDING 257
Provider Business Mailing Address City Name:
JOINT BASE LANGLEY-EUSTIS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23665-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-225-2238
Provider Business Mailing Address Fax Number:
757-225-1807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633D MEDICAL GROUP
Provider Second Line Business Practice Location Address:
77 NEALY AVENUE
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23665-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-225-2238
Provider Business Practice Location Address Fax Number:
757-225-1807
Provider Enumeration Date:
08/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P2201X , with the licence number:  0202207114 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 0202207114 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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