Provider Demographics
NPI:1578261269
Name:NUNLEY, SHATERIA
Entity Type:Individual
Prefix:MS
First Name:SHATERIA
Middle Name:
Last Name:NUNLEY
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 1:3 MILSBURY LN
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-5610
Mailing Address - Country:US
Mailing Address - Phone:706-993-0496
Mailing Address - Fax:
Practice Address - Street 1:3 MILSBURY LN
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-5610
Practice Address - Country:US
Practice Address - Phone:706-993-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist