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General NPI Number Information
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NPI Number | 1780271478
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Entity Type | Individual
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Provider Name | SHONDDA CRISTAE ALLEN
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Gender | Female
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 100 HRESAN BLVD
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-1333
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Country | US
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Telephone | 304-574-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 8824 GATEWOOD RD
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-7204
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Country | US
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Telephone | 681-268-2009
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Fax | 304-471-2488
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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