Provider Demographics
NPI:1073174645
Name:WHITE, SHAQUASIA C
Entity Type:Individual
Prefix:
First Name:SHAQUASIA
Middle Name:C
Last Name:WHITE
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 1:25 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2434
Mailing Address - Country:US
Mailing Address - Phone:917-975-1601
Mailing Address - Fax:
Practice Address - Street 1:494 GEORGIA AVE APT 6P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5784
Practice Address - Country:US
Practice Address - Phone:917-975-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst