Provider Demographics
NPI:1639683550
Name:QUICENO, SHANNA NICOLE
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:NICOLE
Last Name:QUICENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:NICOLE
Other - Last Name:HAMMOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9689 N BELFORT CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1887
Mailing Address - Country:US
Mailing Address - Phone:954-850-3351
Mailing Address - Fax:
Practice Address - Street 1:9689 N BELFORT CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1887
Practice Address - Country:US
Practice Address - Phone:954-850-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other