Individual
MIRANDA SHELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6602 W BROAD ST STE B, RICHMOND, VA 23230-1702
(804) 285-8206
(804) 497-5469
Mailing address
PO BOX 8310, ROANOKE, VA 24014-0310
(540) 345-3556
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009160
VA
Other
Enumeration date
02/09/2023
Last updated
08/28/2023
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