Healthcare Provider Details

I. General information

NPI: 1447844097
Provider Name (Legal Business Name): MS. SHAVONNE PATRIESE RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date: 10/21/2025
Reactivation Date: 11/06/2025

III. Provider practice location address

1030 LOFTIS BLVD STE 103
NEWPORT NEWS VA
23606-2999
US

IV. Provider business mailing address

PO BOX 360595
PITTSBURGH PA
15251
US

V. Phone/Fax

Practice location:
  • Phone: 757-720-0099
  • Fax:
Mailing address:
  • Phone: 718-215-5311
  • Fax: 718-865-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000649
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: