Provider Demographics
NPI:1962717173
Name:RICHARDSON, SHAUNDREA FAULK (CPNP)
Entity type:Individual
Prefix:
First Name:SHAUNDREA
Middle Name:FAULK
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 24TH ST
Mailing Address - Street 2:WILKERSON PEDIATRIC CLINIC
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1716
Mailing Address - Country:US
Mailing Address - Phone:804-734-9125
Mailing Address - Fax:804-734-9011
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:WILKERSON PEDIATRIC CLINIC
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9125
Practice Address - Fax:804-734-9011
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168808363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics