Provider Demographics
NPI:1043676620
Name:SHAVERS, SHA'NEIKA
Entity Type:Individual
Prefix:
First Name:SHA'NEIKA
Middle Name:
Last Name:SHAVERS
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 670
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-0670
Mailing Address - Country:US
Mailing Address - Phone:903-799-7790
Mailing Address - Fax:
Practice Address - Street 1:201 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-1635
Practice Address - Country:US
Practice Address - Phone:903-799-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children