Individual
SHALONDA TENILLE CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2042 MOURNING DOVE DR, LOCUST GROVE, VA 22508-3118
(571) 230-7945
Mailing address
2042 MOURNING DOVE DR, LOCUST GROVE, VA 22508-3118
(571) 230-7945
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A660027663
VA
Other
Enumeration date
06/07/2019
Last updated
06/07/2019
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