Individual
NICOLE MAALOUF SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1622 WESTOVER AVE SW, ROANOKE, VA 24015-5216
(339) 368-1887
Mailing address
1622 WESTOVER AVE SW, ROANOKE, VA 24015-5216
(339) 368-1887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-10795
NC
Other
Enumeration date
04/18/2019
Last updated
07/31/2024
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