Provider Demographics
NPI:1417567272
Name:DICKEY, SHAUNTAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHAUNTAE
Middle Name:
Last Name:DICKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 NATALIE CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-1954
Mailing Address - Country:US
Mailing Address - Phone:850-322-3967
Mailing Address - Fax:
Practice Address - Street 1:2019 NATALIE CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-1954
Practice Address - Country:US
Practice Address - Phone:850-322-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5213636164W00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No253Z00000XAgenciesIn Home Supportive Care