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General NPI Number Information
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NPI Number | 1144897133
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Entity Type | Organization
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Legal Business Name | SHADES OF LIFE LABS LLC
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 138 S ROSEMONT RD STE 210
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4336
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Country | US
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Telephone | 757-431-3000
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Fax | 757-210-9481
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Provider Business Mailing Address
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Address Line | 138 S ROSEMONT RD STE 210
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4336
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Country | US
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Telephone | 757-672-3507
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DIONNE GIBBS
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Credential | RN
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Telephone | 757-472-5434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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