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Individual

SHANTWAN L HUMPHREY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5901 N MACARTHUR BLVD # 1421, IRVING, TX 75039-3807
(214) 664-7058
Mailing address
6932 GREENVILLE AVE # 119, DALLAS, TX 75231-5904
(214) 664-7058

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
35712321
TX

Other

Enumeration date
02/22/2023
Last updated
02/22/2023
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