Provider Demographics
NPI:1629661459
Name:RAGLIN, SHAQUAN SHUNTAY
Entity Type:Individual
Prefix:
First Name:SHAQUAN
Middle Name:SHUNTAY
Last Name:RAGLIN
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 1:3128 JACKAL DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3178
Mailing Address - Country:US
Mailing Address - Phone:254-733-4398
Mailing Address - Fax:
Practice Address - Street 1:3128 JACKAL DR
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-3178
Practice Address - Country:US
Practice Address - Phone:254-733-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer