Individual
SHANE CARLOS CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 S. 5TH ST., RICHMOND, VA 23219
(804) 828-7912
Mailing address
107 S. 5TH ST., RICHMOND, VA 23219
(804) 828-7912
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101265348
VA
Other
Enumeration date
05/04/2017
Last updated
02/27/2025
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