Provider Demographics
NPI:1629027735
Name:DEWBERRY, SHENAY MARVETTA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SHENAY
Middle Name:MARVETTA
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 LIBERTY LANDING CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7617
Mailing Address - Country:US
Mailing Address - Phone:314-630-8062
Mailing Address - Fax:314-434-6066
Practice Address - Street 1:1300 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3163
Practice Address - Country:US
Practice Address - Phone:314-434-6060
Practice Address - Fax:314-434-6066
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist