Individual
MR. SIMEON CHARLES SLAYTON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
10519 GODWIN DR, MANASSAS, VA 20112-2736
(703) 489-9300
(703) 530-0961
Mailing address
10519 GODWIN DR, MANASSAS, VA 20112-2736
(703) 489-9300
(703) 530-0961
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2705 124382
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12L24920
UNIQUE HOMES BUSINESS LICENSE
VA
01
—
2705-124382
CONTRACTORS LISENCE
VA
Enumeration date
09/14/2012
Last updated
09/14/2012
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