Individual
SHANITA ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5101 SPRINGLAKE PKWY APT 1027, HALTOM CITY, TX 76117-1347
(817) 470-1625
Mailing address
5101 SPRINGLAKE PKWY APT 1027, HALTOM CITY, TX 76117-1347
(817) 470-1625
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
06/07/2023
Last updated
07/12/2023
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