Individual
SHENASIA NEWSOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
519 COLONY OAK LN, MIDLOTHIAN, VA 23114-4678
(804) 908-2562
Mailing address
519 COLONY OAK LN, MIDLOTHIAN, VA 23114-4678
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T62983767
VA
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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