Provider Demographics
NPI:1588233282
Name:PRENTICE -GONSALVES, SHUQUIA TINIEQ NIOAMI (DOULA)
Entity Type:Individual
Prefix:
First Name:SHUQUIA
Middle Name:TINIEQ NIOAMI
Last Name:PRENTICE -GONSALVES
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 CONROY RD APT 4275116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-3737
Mailing Address - Country:US
Mailing Address - Phone:352-744-6065
Mailing Address - Fax:
Practice Address - Street 1:5116 CONROY RD APT 4275116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3737
Practice Address - Country:US
Practice Address - Phone:352-744-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula