MEDICARE: DESHANDA ARTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904007803	VA

General Provider Information

NPI Number	:	1699234740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHANDA ARTIS

Provider Business Mailing Address
First Line	:	8710 CHOCTAW RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-3472
Country	:	US
Telephone Number	:	804-282-2115
Fax Number	:

Provider Business Practice Location Address
First Line	:	8710 CHOCTAW RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-3472
Country	:	US
Telephone Number	:	804-282-2115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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Directions to “ DESHANDA ARTIS ” Practice Location

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