Provider Demographics
NPI:1598521528
Name:GLADNEY, SHAKYA M
Entity Type:Individual
Prefix:
First Name:SHAKYA
Middle Name:M
Last Name:GLADNEY
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 1:2807 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3610
Mailing Address - Country:US
Mailing Address - Phone:678-394-6311
Mailing Address - Fax:
Practice Address - Street 1:2807 HICKORY LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3610
Practice Address - Country:US
Practice Address - Phone:678-434-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician