Individual
DALE SHAQUILLE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
671 S KINGS AVE, BRANDON, FL 33511-6048
(813) 972-3750
Mailing address
190 WILLIAMS AVE, RICHMOND HILL, GA 31324-7215
(912) 332-0524
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PENDING
FL
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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