Provider Demographics
NPI:1053832964
Name:DAVID, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SHANA DAVID
Mailing Address - Street 1:155 HANSARD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1604
Mailing Address - Country:US
Mailing Address - Phone:919-559-5176
Mailing Address - Fax:
Practice Address - Street 1:155 HANSARD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-1604
Practice Address - Country:US
Practice Address - Phone:919-559-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician