Provider Demographics
NPI:1083879183
Name:SHELTON-SIMPSON, QIANA NAKEA (DT)
Entity Type:Individual
Prefix:MRS
First Name:QIANA
Middle Name:NAKEA
Last Name:SHELTON-SIMPSON
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 W 120TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5932
Mailing Address - Country:US
Mailing Address - Phone:773-928-0922
Mailing Address - Fax:
Practice Address - Street 1:538 W 120TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-5932
Practice Address - Country:US
Practice Address - Phone:773-928-0922
Practice Address - Fax:708-868-1290
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor