Provider Demographics
NPI:1558071456
Name:SANDERS, SHANQUITA PATRICE (LMT/NMT)
Entity Type:Individual
Prefix:MS
First Name:SHANQUITA
Middle Name:PATRICE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMT/NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-2910
Mailing Address - Country:US
Mailing Address - Phone:205-317-0860
Mailing Address - Fax:
Practice Address - Street 1:1223 2ND AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1305
Practice Address - Country:US
Practice Address - Phone:205-718-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5562225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty