Provider Demographics
NPI:1427947514
Name:COLEMAN, SHADEANA LATOYA (CNA)
Entity type:Individual
Prefix:
First Name:SHADEANA
Middle Name:LATOYA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5394 MAYBANK HIGH WAY
Mailing Address - Street 2:
Mailing Address - City:WADMALAW ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29487
Mailing Address - Country:US
Mailing Address - Phone:843-534-9667
Mailing Address - Fax:
Practice Address - Street 1:5394 MAYBANK HIGH WAY
Practice Address - Street 2:
Practice Address - City:WADMALAW ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29487
Practice Address - Country:US
Practice Address - Phone:843-534-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC167718376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide