Provider Information for 1740726355
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SHANTON ROBERSON
Sex: Female
NPI: 1740726355
Last Updated: 2023-08-15
Certification Date: 2023-08-15
Certification Date: 2023-08-15
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740726355 | ||||||||||||
| Enumeration Date | 2017-01-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 116 DEER SPRINGS RD SW DECATUR, AL 35603-4933 United States Phone: 904-729-1611 | Fax: | ||||||||||||
| Primary Practice Address | 116 DEER SPRINGS RD SW DECATUR, AL 35603-4933 United States Phone: 904-729-1611 | Fax: | ||||||||||||
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