Individual
CONSWALLA U SHAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT045857T
PA
207W00000X
Ophthalmology Physician
Primary
C1-0007808
DE
208D00000X
General Practice Physician
C1-0007808
DE
Other
Enumeration date
01/04/2011
Last updated
04/27/2021
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