Provider Demographics
NPI:1417604992
Name:GRAY GARCIA, SHANIQUA VENTRICIA (MSW)
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:VENTRICIA
Last Name:GRAY GARCIA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NW 183RD ST STE 404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4619
Mailing Address - Country:US
Mailing Address - Phone:786-524-4001
Mailing Address - Fax:
Practice Address - Street 1:111 NW 183RD ST STE 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4619
Practice Address - Country:US
Practice Address - Phone:786-524-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW161491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical