Provider Demographics
NPI:1063919322
Name:HARDY, ANITA SHANELL
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:SHANELL
Last Name:HARDY
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 1:5652 NATHANIEL ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2534
Mailing Address - Country:US
Mailing Address - Phone:757-537-8275
Mailing Address - Fax:757-539-6088
Practice Address - Street 1:5652 NATHANIEL ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2534
Practice Address - Country:US
Practice Address - Phone:757-537-3580
Practice Address - Fax:757-539-6088
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle