Provider Demographics
NPI:1033508056
Name:BILLUPS, SHANEEQUA LAQUANA (CST)
Entity Type:Individual
Prefix:
First Name:SHANEEQUA
Middle Name:LAQUANA
Last Name:BILLUPS
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 COLD SPRING PL
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7636
Mailing Address - Country:US
Mailing Address - Phone:302-228-4309
Mailing Address - Fax:
Practice Address - Street 1:307 COLD SPRING PL
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7636
Practice Address - Country:US
Practice Address - Phone:302-228-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE145649246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist