Provider Demographics
NPI:1306365465
Name:HOLIDAY, SHANEQUA ANNE (MPA)
Entity Type:Individual
Prefix:
First Name:SHANEQUA
Middle Name:ANNE
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1853
Mailing Address - Country:US
Mailing Address - Phone:347-579-6818
Mailing Address - Fax:
Practice Address - Street 1:1711 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1853
Practice Address - Country:US
Practice Address - Phone:347-579-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty