Provider Demographics
NPI:1609210483
Name:HALL, LARITA SHAUNDELL (DO)
Entity type:Individual
Prefix:DR
First Name:LARITA
Middle Name:SHAUNDELL
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 AQUATIC DR
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-2013
Mailing Address - Country:US
Mailing Address - Phone:417-300-4471
Mailing Address - Fax:
Practice Address - Street 1:435 HURFFVILLE CROSS KEYS RD
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2453
Practice Address - Country:US
Practice Address - Phone:856-582-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program