Individual
SHANTELLA RIOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 ACADEMY ST, SOUTH ORANGE, NJ 07079-1906
(347) 933-4122
Mailing address
357 HAWTHORNE AVE FL 2, NEWARK, NJ 07112-1609
(347) 933-4122
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/06/2020
Last updated
05/06/2020
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