Provider Demographics
NPI:1457145138
Name:SHANTZ, AMY LINNEA (LSA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LINNEA
Last Name:SHANTZ
Suffix:
Gender:
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 RICES DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:VA
Mailing Address - Zip Code:23966-2605
Mailing Address - Country:US
Mailing Address - Phone:434-390-4566
Mailing Address - Fax:
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-254-5250
Practice Address - Fax:804-254-5269
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000014246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant