Provider Demographics
NPI:1699264135
Name:FOX, SHANTE L
Entity type:Individual
Prefix:
First Name:SHANTE
Middle Name:L
Last Name:FOX
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 1:2601 MOUNTAINBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2264
Mailing Address - Country:US
Mailing Address - Phone:804-334-2513
Mailing Address - Fax:
Practice Address - Street 1:2601 MOUNTAINBERRY CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2264
Practice Address - Country:US
Practice Address - Phone:804-334-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator