Shanley Brooke Shelburne, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110-005327 Issued in VA

Practice address

1800 Combs Rd
Suite 7
Pennington Gap, VA 24277-1808

Phone

(276) 546-4894

NPI assigned

Apr 21, 2016

Last updated

May 4, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Shanley Brooke Church Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Litton Family Medicine PC

  • Family Medicine Physician
  • Pennington Gap, VA
  • NPI 1285731463
  Medicare reassignment

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493856000000",
    "number": "1679927123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41830 E MORGAN AVE STE 202",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242773218",
            "telephone_number": "336-512-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 COMBS RD",
            "address_2": "SUITE 7",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242771808",
            "telephone_number": "276-546-4894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELBURNE",
        "first_name": "SHANLEY",
        "middle_name": "BROOKE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-21",
        "last_updated": "2017-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110-005327",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "TC481",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANLEY",
            "last_name": "CHURCH",
            "middle_name": "BROOKE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melinda Roop
• Roy S. Shelburne, DDS, LTD
• Martin L Ruppel, LPTA
• Subhash C Saha, M.D.
• Gary Saylor, CRNA
• Stephen Ross Shelburne, DDS
• Southern Home Respiratory & Equipment, Inc.
• SP Lee LLC (Lee Health & Rehab Center)
• Kenneth Patton Speak, CRNA
• Mona Speak, DNP, FNP-BC

• Medical Physician Assistant in Pennington Gap, VA
• Providers in Pennington Gap, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.