Healthcare Provider Details

I. General information

NPI: 1881501401
Provider Name (Legal Business Name): SHALA YEVETTE ROSTICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 BURFORD RD STE B
NORTH CHESTERFIELD VA
23235
US

IV. Provider business mailing address

802 BROOK HILL RD APT 612
RICHMOND VA
23227-2514
US

V. Phone/Fax

Practice location:
  • Phone: 804-806-5044
  • Fax:
Mailing address:
  • Phone: 804-806-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1249530
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: