Provider Demographics
NPI:1124538335
Name:DORSEY, SHENINA
Entity Type:Individual
Prefix:
First Name:SHENINA
Middle Name:
Last Name:DORSEY
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 1:4738 BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5522
Mailing Address - Country:US
Mailing Address - Phone:678-258-5879
Mailing Address - Fax:
Practice Address - Street 1:4738 BEXLEY DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5522
Practice Address - Country:US
Practice Address - Phone:678-258-5879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health