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General NPI Number Information
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NPI Number | 1669933438
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Entity Type | Individual
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Provider Name | SHONDA LASHAY MOORE-STEVENS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 775 PRESTWOOD RD
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City | ALBERTA
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State | VA
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Zip | 23821
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Country | US
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Telephone | 804-677-0732
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Fax | 434-532-4294
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Provider Business Mailing Address
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Address Line | 775 PRESTWOOD RD
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City | ALBERTA
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State | VA
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Zip | 23821
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Country | US
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Telephone | 804-677-0732
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Fax | 434-532-4294
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | T64272744
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License Number State | VA
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