Provider Demographics
NPI:1144231408
Name:SHASHATY, SUSAN EILEEN (RWDC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:EILEEN
Last Name:SHASHATY
Suffix:
Gender:F
Credentials:RWDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10486 RIDGEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3548
Mailing Address - Country:US
Mailing Address - Phone:804-683-6745
Mailing Address - Fax:
Practice Address - Street 1:10486 RIDGEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-3548
Practice Address - Country:US
Practice Address - Phone:804-683-6745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA191553OtherANTHEM