Provider Demographics
NPI:1023576972
Name:WELCH, SYNTERIKA SHANTA
Entity Type:Individual
Prefix:MS
First Name:SYNTERIKA
Middle Name:SHANTA
Last Name:WELCH
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 1:6333 E TATE RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-3779
Mailing Address - Country:US
Mailing Address - Phone:662-209-1133
Mailing Address - Fax:
Practice Address - Street 1:7164 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-4472
Practice Address - Country:US
Practice Address - Phone:662-209-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty