Individual
VICTORIA ROSE SHADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-2134
(336) 713-8583
Mailing address
131 BROADMOOR LN APT A5, WINSTON SALEM, NC 27104-4527
(260) 223-3630
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
2021-01393
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2017
Last updated
06/16/2021
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