Provider Demographics
NPI:1225703093
Name:BONHOMME, SHANIQUA
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:
Last Name:BONHOMME
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 1:1950 SIMMONS ST APT 1138
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1665
Mailing Address - Country:US
Mailing Address - Phone:702-300-1333
Mailing Address - Fax:
Practice Address - Street 1:1950 SIMMONS ST APT 1138
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1665
Practice Address - Country:US
Practice Address - Phone:702-300-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health