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General NPI Number Information
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NPI Number | 1457145138
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Entity Type | Individual
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Provider Name | AMY LINNEA SHANTZ LSA
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 2621 GROVE AVE
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City | RICHMOND
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State | VA
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Zip | 23220-4308
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Country | US
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Telephone | 804-254-5250
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Fax | 804-254-5269
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Provider Business Mailing Address
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Address Line | 546 RICES DEPOT RD
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City | RICE
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State | VA
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Zip | 23966-2605
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Country | US
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Telephone | 434-390-4566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 0136000014
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License Number State | VA
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