Provider Demographics
NPI:1063018216
Name:WINSTON, BIONCCA SHANIECE
Entity Type:Individual
Prefix:
First Name:BIONCCA
Middle Name:SHANIECE
Last Name:WINSTON
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 1:59 QUARTZ RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3712
Mailing Address - Country:US
Mailing Address - Phone:240-203-4105
Mailing Address - Fax:
Practice Address - Street 1:59 QUARTZ RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3712
Practice Address - Country:US
Practice Address - Phone:240-203-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant