Provider Demographics
NPI:1518670074
Name:MCKINNEY, SHAQUITA NIQUAN
Entity Type:Individual
Prefix:MS
First Name:SHAQUITA
Middle Name:NIQUAN
Last Name:MCKINNEY
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 1:740 DUNEDIN RD APT B
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2317
Mailing Address - Country:US
Mailing Address - Phone:757-927-3367
Mailing Address - Fax:757-927-3367
Practice Address - Street 1:740 DUNEDIN RD APT B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2317
Practice Address - Country:US
Practice Address - Phone:757-927-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant