Healthcare Provider Details

I. General information

NPI: 1831775592
Provider Name (Legal Business Name): MISS SHAYNA ANTHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N MILITARY HWY
NORFOLK VA
23502-2425
US

IV. Provider business mailing address

1031 WINWARD RD
NORFOLK VA
23513-3220
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-2125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230032329
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: