Certain details regarding the origin and evolution of shelf sand ridges remain elusive. Knowledge of their internal stratigraphy and microfossil distribution is necessary to define the origin and to determine the processes that modify sand ridges. Fourteen vibracores from False Cape Shoal A, a well-developed shoreface-attached sand ridge on the Virginia/North Carolina inner continental shelf, were examined to document the internal stratigraphy and benthic foraminiferal assemblages, as well as to reconstruct the depositional environments recorded in down-core sediments. Seven sedimentary and foraminiferal facies correspond to the following stratigraphic units: fossiliferous silt, barren sand, clay to sandy clay, laminated and bioturbated sand, poorly sorted massive sand, fine clean sand, and poorly sorted clay to gravel. The units represent a Pleistocene estuary and shoreface, a Holocene estuary, ebb tidal delta, modern shelf, modern shoreface, and swale fill, respectively. The succession of depositional environments reflects a Pleistocene sea-level highstand and subsequent regression followed by the Holocene transgression in which barrier island/spit systems formed along the Virginia/North Carolina inner shelf not, vert, ~5.2 ka and migrated landward and an ebb tidal delta that was deposited, reworked, and covered by shelf sand.