Provider Demographics
NPI:1225712227
Name:BAILEY, SHANAE DIANE
Entity Type:Individual
Prefix:
First Name:SHANAE
Middle Name:DIANE
Last Name:BAILEY
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 1:1725 Q ST SE APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5557
Mailing Address - Country:US
Mailing Address - Phone:120-288-3156
Mailing Address - Fax:
Practice Address - Street 1:1725 Q ST SE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5557
Practice Address - Country:US
Practice Address - Phone:202-883-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management