Individual
MISS SHANTA DOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 DUNCAN AVE, SWANSEA, IL 62226-1732
(618) 974-4807
Mailing address
3922 N BELT W, BELLEVILLE, IL 62226-5608
(618) 974-4807
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/06/2018
Last updated
04/27/2022
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