Kelley Shanahan (NPI# 1134676877, PAC ID# 2668753013) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1134676877 |
| PAC ID by PECOS | 2668753013 |
| Professional Enrollment ID | I20161227001182 |
| Full Name | Kelley Shanahan |
| Organization Legal Name | BON SECOURS-VIRGINIA HEALTHSOURCE INC |
| Address |
10571 Telegraph Rd Suite 130 Glen Allen VA 23059-4652 |
| Phone Number | 8042667611 |
| Gender | F |
| Graduation Year | 2016 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 3072411479 |
| Number of Group Practice Members | 33 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490069 | BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER |
| 490059 | BON SECOURS ST MARYS HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 10571 Telegraph Rd, Suite 130, Glen Allen, VA 23059-4652 | 8042667611 | BON SECOURS-VIRGINIA HEALTHSOURCE INC |
| Organization Legal Name | BON SECOURS-VIRGINIA HEALTHSOURCE INC |
| Physicians | 33 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael E Kelly | Cardiovascular Disease (cardiology) | Bon Secours-virginia Healthsource Inc | 1362 Tappahannock Blvd, Tappahannock, VA 22560-9309 |
| Berna A Seabrook | Nurse Practitioner | Bon Secours-virginia Healthsource Inc | 2421 Chamberlayne Ave, Richmond, VA 23222-4205 |
| James R Daniels Jr. | General Surgery | Bon Secours-virginia Healthsource Inc | 5855 Bremo Rd, Suite 506, Richmond, VA 23226-1925 |
| George Parker | General Practice | Bon Secours-virginia Healthsource Inc | 1362 Tappahannock Blvd, Tappahannock, VA 22560-9309 |
| Cecilia L Santos | Internal Medicine | Bon Secours-virginia Healthsource Inc | 101 Harris Rd, Kilmarnock, VA 22482-3880 |
| Brennan J Carmody | General Surgery | Bon Secours-virginia Healthsource Inc | 5855 Bremo Rd, Suite 506, Richmond, VA 23226-1925 |
| Allen Y Tsui | Family Medicine | Bon Secours-virginia Healthsource Inc | 1362 Tappahannock Blvd, Tappahannock, VA 22560-9309 |
| Joynita M Nicholson | Family Medicine | Bon Secours-virginia Healthsource Inc | 1362 Tappahannock Blvd, Tappahannock, VA 22560-9309 |
| Michael A White | General Surgery | Bon Secours-virginia Healthsource Inc | 5855 Bremo Rd, Suite 506, Richmond, VA 23226-1925 |
| Archer Lewis Baskerville | Cardiovascular Disease (cardiology) | Bon Secours-virginia Healthsource Inc | 1362 Tappahannock Blvd, Tappahannock, VA 22560-9309 |
| Street Address |
10571 TELEGRAPH RD SUITE 130 |
| City | GLEN ALLEN |
| State | VA |
| Zip | 23059-4652 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amy K Teague | Physician Assistant | Bon Secours-virginia Healthsource Inc | 10571 Telegraph Rd, Suite 130, Glen Allen, VA 23059-4652 |
| Angela L Tucker | Nurse Practitioner | Bon Secours-virginia Healthsource Inc | 10571 Telegraph Rd, Suite 130, Glen Allen, VA 23059-4652 |
| Stephen G Read | Family Medicine | Bon Secours-virginia Healthsource Inc | 10571 Telegraph Rd, Suite 130, Glen Allen, VA 23059-4652 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Cherine M Vanwagner | Chiropractic | 11520 Nuckols Rd, Suite 101, Glen Allen, VA 23059-2558 | |
| Shoshana D Katz | Physician Assistant | Physical Medicine Associates Ltd | 5213 Hickory Park Dr, B, Glen Allen, VA 23059-2617 |
| Andrea M Stern | Psychologist, Clinical | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Beth Mcgraw | Psychologist, Clinical | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Jill Ascari | Psychologist, Clinical | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Sailatha Bobba | Psychiatry | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Kate T Tibbs | Nurse Practitioner | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Allison Revenson | Clinical Social Worker | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Stephanie B Johnson | Psychologist, Clinical | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Wendy S Cohen | Psychiatry | Commonwealth Counseling Associates PC | 5213 Hickory Park Dr A, Glen Allen, VA 23059-2617 |
| Find all physicians in zip 23059 | |||
| City | GLEN ALLEN |
| Zip Code | 23059 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | GLEN ALLEN + NURSE PRACTITIONER |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.