person
Shahauna Latia Mallery, PMHNP-BC
Psychiatric/Mental Health Nurse Practitioner in Suffolk, Virginia
NPI 1861199184

Shahauna Latia Mallery is a Psychiatric/Mental Health Nurse Practitioner based in Suffolk, VA and is specialized in Psychiatric/Mental Health. Shahauna Latia Mallery practices in Suffolk, VA and has the professional credentials of PMHNP-BC. The NPI Number for Shahauna Latia Mallery is 1861199184 and holds a License No. 0024186470 (Virginia).

The current practice location address for Shahauna Latia Mallery is 3897 Bridge Rd Ste 104, Suffolk, VA and can be reached out via phone at 757-758-6001. You can also correspond with Shahauna Latia Mallery through the mailing address at 3897 BRIDGE RD STE 104, SUFFOLK, VA - 23435-1911 (mailing address contact number: 757-758-6001).

Location: 3897 Bridge Rd Ste 104, Suffolk, VA, 23435-1911
person
Provider Profile Details
NPI Number
1861199184
Provider Name
Shahauna Latia Mallery
Credential
PMHNP-BC
Provider Entity Type
Individual
Gender
Female
Address
3897 Bridge Rd Ste 104, Suffolk, VA, 23435-1911
Phone Number
757-758-6001
Fax Number
Provider Enumeration Date
02/08/2023
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0001227876 01 VA VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
0024186470 01 VA VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
institution
Provider Business Practice Location Address Details
Address
3897 Bridge Rd Ste 104
City
State
Zip
23435-1911
Phone Number
757-758-6001
Fax Number
person
Provider Business Mailing Address Details
Address
3897 Bridge Rd Ste 104
City
State
Zip
23435-1911
Phone Number
757-758-6001
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Psychiatric/Mental Health
Taxonomy
License No.
0024186470 (Virginia)
Definition
Definition to come...
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