Individual
SHACOYA ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6118 SAINT GILES ST STE 130, RALEIGH, NC 27612-7099
(919) 910-0800
Mailing address
4813 KITLEDGE DR, RALEIGH, NC 27610-6624
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
96398
NC
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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