Provider Demographics
NPI:1194195636
Name:TOWNSEND, SHAHAMA TAQUITA (RN)
Entity Type:Individual
Prefix:
First Name:SHAHAMA
Middle Name:TAQUITA
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BERNARD ST # DN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5755
Mailing Address - Country:US
Mailing Address - Phone:585-754-6997
Mailing Address - Fax:
Practice Address - Street 1:187 BERNARD ST # DN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5755
Practice Address - Country:US
Practice Address - Phone:585-754-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705134-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse