Provider Demographics
NPI:1053718155
Name:MASON, ROSITA SHIRLEY
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:SHIRLEY
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-0523
Mailing Address - Country:US
Mailing Address - Phone:804-300-9138
Mailing Address - Fax:
Practice Address - Street 1:601 YORK AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1635
Practice Address - Country:US
Practice Address - Phone:804-300-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator