Provider Demographics
NPI:1780469684
Name:GONZALEZ, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GONZALEZ
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:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:DOSWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23047-0195
Mailing Address - Country:US
Mailing Address - Phone:804-393-5128
Mailing Address - Fax:
Practice Address - Street 1:7700 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4301
Practice Address - Country:US
Practice Address - Phone:804-393-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula