Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
SHAWANA ROACH
Active Sole ProprietorIntellectual Disabilities Residential Treatment Facility · DISPUTANTA, VA
Registration Details
- NPI Number
- 1790276186
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- May 22, 2018 (7.9169369211684 yrs)
- Last Updated
- May 22, 2018
- License
-
2452--01-001 (VA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
10424 WALTON LAKE RDDISPUTANTA, VA, 238424703Browse VA providers · Browse ZIP 23842
- Phone
- 7574770424
- Primary Specialty
-
Intellectual Disabilities Residential Treatment Facility
320600000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.