Provider Demographics
NPI:1467036392
Name:DORSEY, SHANI
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:DORSEY
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 1:3024 MACALLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7268
Mailing Address - Country:US
Mailing Address - Phone:804-286-2595
Mailing Address - Fax:804-554-9506
Practice Address - Street 1:3024 MACALLAN PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-7268
Practice Address - Country:US
Practice Address - Phone:804-286-2595
Practice Address - Fax:804-554-9506
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty