Provider Demographics
NPI:1154345932
Name:SNODGRASS, SHELLEY L (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5168
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:53 S MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2333
Practice Address - Country:US
Practice Address - Phone:540-932-5687
Practice Address - Fax:540-932-5688
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH38253Medicare UPIN
VA498728Medicare ID - Type Unspecified
VAC06769Medicare PIN
VAP00478293Medicare PIN
VAGC1100Medicare PIN