Individual
SHAYLIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
525 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23451-6119
(757) 428-2666
(757) 451-7307
Mailing address
525 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23451-6119
(757) 428-2666
(757) 451-7307
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
0230023817
VA
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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