Individual provider Active NPI

Shelby M Wall, NP

  • Adult Health Nurse Practitioner
  • Norfolk, VA
National Provider Identifier
1366951717
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
0024175445 Issued in VA
Practice address
600 Gresham Dr FL 5
Norfolk, VA 23507-1904
Phone
(757) 388-3198
Fax
(757) 388-4242
NPI assigned
Sep 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024175445 VA
Adult Health Nurse Practitioner 363LA2200X 0024175445 VA Primary

Addresses

Primary practice location

600 Gresham Dr FL 5
Norfolk, VA 23507-1904

Mailing address

600 Gresham Dr FL 5
Norfolk, VA 23507-1904
Phone (757) 388-3198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171215000028 VA Practitioner - Nurse Practitioner 1254699515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456-0178
Phone (757) 507-4123

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
PA11719TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group CurrentSince Jan 8, 2018 Accepting new patients

Locations

600 Gresham Dr
Norfolk, VA 23507
Phone (757) 473-0055

844 Kempsville Rd
Ste 204
Norfolk, VA 23502
Phone (757) 261-0700

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

600 Gresham Dr
Fl 5
Norfolk, VA 23507
Phone (757) 388-3198

1060 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 395-2323

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456
Phone (757) 507-1000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580947200000",
    "number": "1366951717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR FL 5",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-3198",
            "fax_number": "757-388-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR FL 5",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-3198",
            "fax_number": "757-388-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SHELBY",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024175445",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024175445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.