LALETHA SHABAZZ (PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1679284624

LALETHA SHABAZZ (PMHNP) is a healthcare provider. based in Portsmouth, Virginia. specializing in NURSE PRACTITIONER. They hold the professional credentials PMHNP. They hold a License No. 0001207047 (VA). The NPI Number for LALETHA SHABAZZ (PMHNP) is 1679284624

Main info

Female
Sole Proprietor
4 Years Of Experience
Accepts Medicare Assignment
Name
LALETHA SHABAZZ (PMHNP)
NPI
1679284624
Phone
Not provided
Address
3511 CARDINAL LN
Enumeration Date
12 December 2022
Last Update Date
16 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7577939483
Graduation Year
2022 (4 years ago)
PAC ID
4981061389
Group Practice PAC ID
8729409784
Professional Enrollment ID
I20230530002515
Address ID
VA234301858SM1801XSTXX401
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:3State licenses:2Digital endpointsOther names

8,307 NURSE PRACTITIONER in VA

Provider Addresses for LALETHA SHABAZZ (PMHNP)

  • 3511 CARDINAL LN

    PORTSMOUTH, VA 237033646

    Phone:

    Type: Mailing

  • 1801 S CHURCH ST

    SMITHFIELD, VA 234301858

    Phone: (757) 793-9483

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 28 Open Payments records for all available years, with a total value of $779.

Total Amount is formed as General ($779) + Research ($0) + Ownership ($0) = $779.

Last reported payment date: 2024-12-18 • Largest payer in this snapshot: ITI, Inc. (d/b/a Intra-Cellular Therapies, Inc.) ($183).

Total Amount

$779

General + Research + Ownership

Payments

28

Total payment records

General Amount

$779

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-18

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-05-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230530002515INurse PractitionerVATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 23703)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8729409784View full group profile
NameSpecialtyState
Nurse PractitionerVA
Nurse PractitionerVA

Reviews

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Frequently asked questions

Is LALETHA SHABAZZ (PMHNP) listed with a National Provider Identifier?
Yes — LALETHA SHABAZZ (PMHNP) has NPI 1679284624 on file in the registry.
Is LALETHA SHABAZZ (PMHNP) still an active registrant?
LALETHA SHABAZZ (PMHNP) carries an active NPI according to the public dataset.
How would a patient describe LALETHA SHABAZZ (PMHNP)'s focus?
For LALETHA SHABAZZ (PMHNP), the primary taxonomy reads as Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Virginia is LALETHA SHABAZZ (PMHNP) registered?
Use Portsmouth, Virginia as the headline location for LALETHA SHABAZZ (PMHNP) here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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