Provider Demographics
NPI:1598367963
Name:MCCLAIN, SHANIKA LATRICE
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:LATRICE
Last Name:MCCLAIN
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 1:2421 S CARRIER PKWY APT 1725
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3874
Mailing Address - Country:US
Mailing Address - Phone:254-251-4403
Mailing Address - Fax:
Practice Address - Street 1:2421 S CARRIER PKWY APT 1725
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3874
Practice Address - Country:US
Practice Address - Phone:254-251-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant