Provider Demographics
NPI:1083278329
Name:WRIGHT, SHANAE L (CD)
Entity Type:Individual
Prefix:MS
First Name:SHANAE
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 KENSINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1054
Mailing Address - Country:US
Mailing Address - Phone:803-504-5086
Mailing Address - Fax:
Practice Address - Street 1:1057 KENSINGTON SQ
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1054
Practice Address - Country:US
Practice Address - Phone:803-504-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty