Provider Demographics
NPI:1174139653
Name:TUCKER, SHANAE PRECIOUS
Entity type:Individual
Prefix:
First Name:SHANAE
Middle Name:PRECIOUS
Last Name:TUCKER
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 1:25114 MEMPHIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2557
Mailing Address - Country:US
Mailing Address - Phone:347-455-6740
Mailing Address - Fax:
Practice Address - Street 1:45 W GUDE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1293
Practice Address - Country:US
Practice Address - Phone:240-740-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool