Individual
SHANTHA DAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(757) 889-5157
Mailing address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(757) 889-5157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101240124
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902926827
—
VA
Enumeration date
04/02/2007
Last updated
06/28/2013
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