Provider Demographics
NPI:1114782018
Name:VEREEN, SHATARA LOUISE (CHW, CD, CHHC)
Entity Type:Individual
Prefix:
First Name:SHATARA
Middle Name:LOUISE
Last Name:VEREEN
Suffix:
Gender:F
Credentials:CHW, CD, CHHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 SW 136TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-6836
Mailing Address - Country:US
Mailing Address - Phone:352-209-5126
Mailing Address - Fax:
Practice Address - Street 1:1111 NE 25TH AVE STE 403
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5668
Practice Address - Country:US
Practice Address - Phone:352-209-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCCHW.0100478172V00000X
FL171400000X, 174H00000X, 376J00000X
FL202311260374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
No376J00000XNursing Service Related ProvidersHomemaker