Provider Demographics
NPI:1043800121
Name:JUGGINS, SHELLEY SHANAY (CNA AND RMA AND BSHA)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SHANAY
Last Name:JUGGINS
Suffix:
Gender:F
Credentials:CNA AND RMA AND BSHA
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:SHANAY
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA AND RMA AND BSHA
Mailing Address - Street 1:691 WELSH DR
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-1156
Mailing Address - Country:US
Mailing Address - Phone:703-687-8491
Mailing Address - Fax:
Practice Address - Street 1:691 WELSH DR
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-1156
Practice Address - Country:US
Practice Address - Phone:703-687-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide