Provider Demographics
NPI:1366028466
Name:WATSON, SHAQUITA MONAE
Entity Type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:MONAE
Last Name:WATSON
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 1:3210 CHURCHLAND BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5253
Mailing Address - Country:US
Mailing Address - Phone:757-785-6263
Mailing Address - Fax:
Practice Address - Street 1:3210 CHURCHLAND BLVD STE 5
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5253
Practice Address - Country:US
Practice Address - Phone:757-785-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
861647313OtherIRS