Provider Demographics
NPI:1164283651
Name:BUSH, SHANEKA LASHELLAI
Entity Type:Individual
Prefix:
First Name:SHANEKA
Middle Name:LASHELLAI
Last Name:BUSH
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 1:503 14TH ST NE BSMT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5411
Mailing Address - Country:US
Mailing Address - Phone:120-275-1662
Mailing Address - Fax:
Practice Address - Street 1:503 14TH ST NE BSMT
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5411
Practice Address - Country:US
Practice Address - Phone:120-275-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator