Provider Demographics
NPI:1346905213
Name:JETER, SHONDA SCALES
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:SCALES
Last Name:JETER
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 1:2345 FOSTERDALE WEST LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7886
Mailing Address - Country:US
Mailing Address - Phone:336-539-6701
Mailing Address - Fax:
Practice Address - Street 1:2345 FOSTERDALE WEST LN
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7886
Practice Address - Country:US
Practice Address - Phone:336-539-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC192052376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide