Individual
SHELLA ANGE VIRGILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5500 TABOR AVE, PHILADELPHIA, PA 19120-2124
(215) 245-2131
Mailing address
8925 FAIRFIELD ST, PHILADELPHIA, PA 19152-1332
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
TGPN030600
PA
Other
Enumeration date
11/15/2019
Last updated
11/15/2019
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