Individual
SHATAE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
805 CENTRAL DR APT 174, BEDFORD, TX 76022-7806
(817) 823-6370
Mailing address
1300 HARWOOD RD UNIT 210211, BEDFORD, TX 76095-1508
(817) 823-6370
(817) 859-7776
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/16/2021
Last updated
09/23/2021
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