Provider Demographics
NPI:1619755402
Name:DINKINS, SHANECKA
Entity Type:Individual
Prefix:
First Name:SHANECKA
Middle Name:
Last Name:DINKINS
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 1:5025 BAY CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2718
Mailing Address - Country:US
Mailing Address - Phone:480-319-0043
Mailing Address - Fax:
Practice Address - Street 1:5025 BAY CIR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2718
Practice Address - Country:US
Practice Address - Phone:480-319-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8598-08-011372500000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No251C00000XAgenciesDay Training, Developmentally Disabled Services