Provider Demographics
NPI:1164160180
Name:JENKINS, SHANEYA TENEE
Entity Type:Individual
Prefix:MS
First Name:SHANEYA
Middle Name:TENEE
Last Name:JENKINS
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 1:2506 W OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3609
Mailing Address - Country:US
Mailing Address - Phone:215-987-9273
Mailing Address - Fax:215-607-2983
Practice Address - Street 1:2506 W OAKDALE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3609
Practice Address - Country:US
Practice Address - Phone:215-987-9273
Practice Address - Fax:215-607-2983
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA51303601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health