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General NPI Number Information
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NPI Number | 1679284624
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Entity Type | Individual
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Provider Name | LALETHA SHABAZZ PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 1801 S CHURCH ST
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City | SMITHFIELD
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State | VA
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Zip | 23430-1858
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Country | US
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Telephone | 757-793-9483
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Fax |
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Provider Business Mailing Address
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Address Line | 3511 CARDINAL LN
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City | PORTSMOUTH
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State | VA
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Zip | 23703-3646
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001207047
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024186473
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License Number State | VA
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