Provider Demographics
NPI:1245789577
Name:HILL, SHAUNDRA
Entity Type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:
Last Name:HILL
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 1:7909 S SAM HOUSTON PKWY E APT 1028
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4799
Mailing Address - Country:US
Mailing Address - Phone:832-829-2869
Mailing Address - Fax:
Practice Address - Street 1:7909 S SAM HOUSTON PKWY E APT 1028
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4799
Practice Address - Country:US
Practice Address - Phone:832-829-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X, 385HR2065X, 385HR2060X, 385HR2055X
TX09676372347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No347C00000XTransportation ServicesPrivate Vehicle