Provider Demographics
NPI:1144407966
Name:TATE, SHAMAYNE (LAC)
Entity Type:Individual
Prefix:
First Name:SHAMAYNE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7410 SWITZER ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-4550
Mailing Address - Country:US
Mailing Address - Phone:913-962-7408
Mailing Address - Fax:913-962-7416
Practice Address - Street 1:7410 SWITZER ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-4550
Practice Address - Country:US
Practice Address - Phone:913-962-7408
Practice Address - Fax:913-962-7416
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1151171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist