Provider Demographics
NPI:1053814442
Name:ABRAMS, SHAUNTAY (LVN)
Entity Type:Individual
Prefix:
First Name:SHAUNTAY
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 FERRARA CIR UNIT A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8218
Mailing Address - Country:US
Mailing Address - Phone:254-314-4753
Mailing Address - Fax:
Practice Address - Street 1:713 FERRARA CIR UNIT A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-8218
Practice Address - Country:US
Practice Address - Phone:254-314-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341917164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse