Individual
SHAVON COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
168 WILLIAMS ST, PORTSMOUTH, VA 23704-1835
(757) 759-1619
Mailing address
1021 EDEN WAY NORTH PMB 339, STE 118, CHESAPEAKE, VA 23320
(757) 759-1619
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
43990-167-465-8163
VA
2083T0002X
Medical Toxicology (Preventive Medicine) Physician
Primary
43990-167-465-8163
VA
247200000X
Other Technician
—
—
Other
Enumeration date
11/03/2022
Last updated
01/12/2024
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