Individual
SHOUDLIE MANOTTE JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SA-C
Contact information
Practice address
5811 BUSTLETON AVE, PHILADELPHIA, PA 19149-3405
(347) 444-0241
Mailing address
5811 BUSTLETON AVE, PHILADELPHIA, PA 19149-3405
(347) 444-0241
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
19-399
FL
Other
Enumeration date
09/29/2019
Last updated
09/29/2019
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