Provider Demographics
NPI:1285190926
Name:MCFADDEN, ROSHONDA
Entity Type:Individual
Prefix:MRS
First Name:ROSHONDA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WINDING CREEK CIR APT P
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1541
Mailing Address - Country:US
Mailing Address - Phone:434-770-3994
Mailing Address - Fax:
Practice Address - Street 1:12 WINDING CREEK CIR APT P
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1541
Practice Address - Country:US
Practice Address - Phone:434-770-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service