Provider Demographics
NPI:1275206542
Name:BYRD, SHANIJUA E
Entity Type:Individual
Prefix:
First Name:SHANIJUA
Middle Name:E
Last Name:BYRD
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 1:707 ANN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2354
Mailing Address - Country:US
Mailing Address - Phone:601-695-4139
Mailing Address - Fax:
Practice Address - Street 1:707 ANN ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2354
Practice Address - Country:US
Practice Address - Phone:601-695-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator