Provider Demographics
NPI:1023674645
Name:VONTOURE, SHULOUNDA
Entity type:Individual
Prefix:
First Name:SHULOUNDA
Middle Name:
Last Name:VONTOURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHULOUNDA
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3211 CALISHA CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1598
Mailing Address - Country:US
Mailing Address - Phone:601-622-7206
Mailing Address - Fax:
Practice Address - Street 1:3211 CALISHA CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1598
Practice Address - Country:US
Practice Address - Phone:601-622-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner