Provider Demographics
NPI:1639767593
Name:DALTON, SHANIKA SHEVONE (NCCPSS)
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:SHEVONE
Last Name:DALTON
Suffix:
Gender:F
Credentials:NCCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 NE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-5514
Mailing Address - Country:US
Mailing Address - Phone:336-918-9028
Mailing Address - Fax:336-829-5610
Practice Address - Street 1:2006 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5514
Practice Address - Country:US
Practice Address - Phone:336-918-9028
Practice Address - Fax:336-829-5610
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist