Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | 1204018546 | VA |
NPI | 1124347588 |
---|---|
Provider Name | Ms. Shaneaka Latisha Price |
First Address | Virginia Beach, VA 23452-2842 |
Second Address | Virginia Beach, VA 23452-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 07/03/2016 |