Provider Demographics
NPI:1912772377
Name:ALLEN, SHAVONE MONIQUE (CPRS)
Entity Type:Individual
Prefix:MS
First Name:SHAVONE
Middle Name:MONIQUE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WILLOW LAWN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3429
Mailing Address - Country:US
Mailing Address - Phone:804-874-9693
Mailing Address - Fax:
Practice Address - Street 1:1510 WILLOW LAWN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3429
Practice Address - Country:US
Practice Address - Phone:804-874-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735000418175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist