Provider Demographics
NPI:1275268666
Name:THOMPSON-WHITE, SHANNAKAY JUDDIAN
Entity Type:Individual
Prefix:
First Name:SHANNAKAY
Middle Name:JUDDIAN
Last Name:THOMPSON-WHITE
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 1:1205 SHELMIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2726
Mailing Address - Country:US
Mailing Address - Phone:856-392-9900
Mailing Address - Fax:
Practice Address - Street 1:1255 WHITEHORSE MERCERVILLE RD STE 503
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3800
Practice Address - Country:US
Practice Address - Phone:609-838-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19666000163W00000X
PARN695502163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse