Provider Demographics
NPI:1770299554
Name:FULTON, VASHTI JANAE
Entity type:Individual
Prefix:
First Name:VASHTI
Middle Name:JANAE
Last Name:FULTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VASHTI
Other - Middle Name:JANAE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10604 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3104
Mailing Address - Country:US
Mailing Address - Phone:803-876-4410
Mailing Address - Fax:
Practice Address - Street 1:10604 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3104
Practice Address - Country:US
Practice Address - Phone:803-876-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver