Provider Demographics
NPI:1093324451
Name:HERRING, SHANTA W
Entity Type:Individual
Prefix:
First Name:SHANTA
Middle Name:W
Last Name:HERRING
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 1:1315 SW ZESTY CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0723
Mailing Address - Country:US
Mailing Address - Phone:386-688-3375
Mailing Address - Fax:
Practice Address - Street 1:1315 SW ZESTY CIR APT 103
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0723
Practice Address - Country:US
Practice Address - Phone:386-688-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker