Provider Demographics
NPI:1124667340
Name:RIDDICK, SHALANDA
Entity type:Individual
Prefix:
First Name:SHALANDA
Middle Name:
Last Name:RIDDICK
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 1:1101 HAMILTON ST STE 160
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1043
Mailing Address - Country:US
Mailing Address - Phone:484-550-6388
Mailing Address - Fax:
Practice Address - Street 1:1101 HAMILTON ST STE 160
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1043
Practice Address - Country:US
Practice Address - Phone:484-550-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2023-11-07
Deactivation Date:2020-01-08
Deactivation Code:
Reactivation Date:2023-11-07
Provider Licenses
StateLicense IDTaxonomies
PA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)