Individual
SHONDESHA GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
612 ASHLEY AVE, SUFFOLK, VA 23434-5904
(757) 371-6533
(757) 809-0691
Mailing address
612 ASHLEY AVE, SUFFOLK, VA 23434-5904
(757) 371-6533
(757) 809-0691
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
0031010685
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824529499
—
VA
Enumeration date
05/21/2019
Last updated
05/21/2019
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