Provider Demographics
NPI:1669933438
Name:MOORE-STEVENS, SHONDA LASHAY
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:LASHAY
Last Name:MOORE-STEVENS
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 1:775 PRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821
Mailing Address - Country:US
Mailing Address - Phone:804-677-0732
Mailing Address - Fax:434-532-4294
Practice Address - Street 1:775 PRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:ALBERTA
Practice Address - State:VA
Practice Address - Zip Code:23821
Practice Address - Country:US
Practice Address - Phone:804-677-0732
Practice Address - Fax:434-532-4294
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT64272744347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle