Individual
DR. LELLISE TAYE SHEWAKENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1060 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23454-3002
(757) 395-8000
(757) 340-4278
Mailing address
1890 METRO CENTER DR, RESTON, VA 20190-5222
(703) 709-1667
(703) 709-1669
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101247521
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336380633
—
VA
Enumeration date
03/16/2009
Last updated
06/13/2021
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