Provider Demographics
NPI:1093411126
Name:MARTINES, SHENDRI'ANNA RAYLYNN
Entity Type:Individual
Prefix:
First Name:SHENDRI'ANNA
Middle Name:RAYLYNN
Last Name:MARTINES
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 1:7000 LOUISIANA BLVD NE APT 1210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3977
Mailing Address - Country:US
Mailing Address - Phone:479-847-6634
Mailing Address - Fax:
Practice Address - Street 1:9400 HOLLY AVE NE BLDG 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2969
Practice Address - Country:US
Practice Address - Phone:505-785-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health