Individual
SHAVONDAH PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6714 ETZEL AVE, SAINT LOUIS, MO 63130-2427
(314) 941-2705
(314) 769-9717
Mailing address
PO BOX 4919, SAINT LOUIS, MO 63108-0919
(314) 941-2705
(314) 769-9717
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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