Provider Demographics
NPI:1912343062
Name:MASSIE, SHALENE YOUNG (CD)
Entity Type:Individual
Prefix:
First Name:SHALENE
Middle Name:YOUNG
Last Name:MASSIE
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 DEERFIELD LN NE
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-3724
Mailing Address - Country:US
Mailing Address - Phone:540-759-4056
Mailing Address - Fax:
Practice Address - Street 1:612 DEERFIELD LN NE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-3724
Practice Address - Country:US
Practice Address - Phone:540-759-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula