Provider Demographics
NPI:1558717272
Name:GUSMAN, SHAR-NEQUI
Entity Type:Individual
Prefix:
First Name:SHAR-NEQUI
Middle Name:
Last Name:GUSMAN
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:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:LIGHTFOOT
Mailing Address - State:VA
Mailing Address - Zip Code:23090-0572
Mailing Address - Country:US
Mailing Address - Phone:757-880-3067
Mailing Address - Fax:
Practice Address - Street 1:12727 MCMANUS BLVD # G
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4459
Practice Address - Country:US
Practice Address - Phone:757-846-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst