Provider Demographics
NPI:1932637071
Name:WILLS, SHALETTA SHERREL (DRIVER)
Entity Type:Individual
Prefix:
First Name:SHALETTA
Middle Name:SHERREL
Last Name:WILLS
Suffix:
Gender:F
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 ALLISON DR # 2116
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4704
Mailing Address - Country:US
Mailing Address - Phone:757-672-6044
Mailing Address - Fax:
Practice Address - Street 1:2116 ALLISON DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-4704
Practice Address - Country:US
Practice Address - Phone:757-288-4596
Practice Address - Fax:757-288-4596
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver