Individual
SHELBY KLOOSTERBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
46440 BENEDICT DRIVE, SUITE 107, STERLING, VA 20164-6602
(703) 450-1125
(703) 450-1145
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007652
VA
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679105530
—
VA
05
—
30016389950001
—
VA
Enumeration date
02/10/2020
Last updated
03/07/2024
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