Provider Demographics
NPI:1518597897
Name:JONES, DE SHUNDA SIMONE
Entity Type:Individual
Prefix:MS
First Name:DE SHUNDA
Middle Name:SIMONE
Last Name:JONES
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 1:8549 LANGLEY MILL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7320
Mailing Address - Country:US
Mailing Address - Phone:980-202-2717
Mailing Address - Fax:
Practice Address - Street 1:8549 LANGLEY MILL CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7320
Practice Address - Country:US
Practice Address - Phone:980-202-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8012133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist