Basic Information
| Provider Information | |||||||||
| NPI: | 1275706269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIBESHI | ||||||||
| FirstName: | MESFIN | ||||||||
| MiddleName: | RESE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365100 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 759 S MAIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226641156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404591354 | ||||||||
| FaxNumber: | 5404591355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0102203781 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.