Individual
SHANTENY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 E CARY ST, RICHMOND, VA 23223-7024
(804) 306-3096
Mailing address
808 GRAYFOX DR, RICHMOND, VA 23223-5667
(804) 306-3096
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
2325
VA
Other
Enumeration date
09/04/2023
Last updated
09/27/2023
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