Provider Demographics
NPI:1053202036
Name:WEATHERS, SHAKEBA S (NP)
Entity type:Individual
Prefix:MRS
First Name:SHAKEBA
Middle Name:S
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FAIRFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-4221
Mailing Address - Country:US
Mailing Address - Phone:804-443-1040
Mailing Address - Fax:
Practice Address - Street 1:1701 FAIRFIELD WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4221
Practice Address - Country:US
Practice Address - Phone:804-433-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024193854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily