Provider Demographics
NPI:1275247033
Name:WASHINGTON, SHEKEIDRA S
Entity Type:Individual
Prefix:
First Name:SHEKEIDRA
Middle Name:S
Last Name:WASHINGTON
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 1:3501 BON AIRE DR APT 165
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3054
Mailing Address - Country:US
Mailing Address - Phone:504-892-2626
Mailing Address - Fax:
Practice Address - Street 1:11 CABUCK LN
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-7402
Practice Address - Country:US
Practice Address - Phone:318-728-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant