Provider Demographics
NPI:1902117344
Name:SHICK, DEVON ALLISON (MD)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:ALLISON
Last Name:SHICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-842-6180
Mailing Address - Fax:757-842-6181
Practice Address - Street 1:1419 CEDAR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7492
Practice Address - Country:US
Practice Address - Phone:757-842-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFS3935814OtherDEA#
VA0101254151OtherBOARD OF MEDICINE LICENSE TO PRACTICE MEDICINE & SURGERY