Provider Demographics
NPI:1558091082
Name:ETIER, SHAMELYA MARIE (CMA)
Entity Type:Individual
Prefix:
First Name:SHAMELYA
Middle Name:MARIE
Last Name:ETIER
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 MEADOWCOVE CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2725
Mailing Address - Country:US
Mailing Address - Phone:469-778-8185
Mailing Address - Fax:
Practice Address - Street 1:13151 EMILY RD STE 109
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-8989
Practice Address - Country:US
Practice Address - Phone:469-677-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty