Provider Demographics
NPI:1578016945
Name:DELOATCH, SHANTE
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:
Last Name:DELOATCH
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 1:601 HILLPOINT BLVD APT 713
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8194
Mailing Address - Country:US
Mailing Address - Phone:434-632-9186
Mailing Address - Fax:
Practice Address - Street 1:601 HILLPOINT BLVD APT 713
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8194
Practice Address - Country:US
Practice Address - Phone:434-632-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker