Provider Demographics
NPI:1659491280
Name:WHITAKER, VINESHIA LASHELL
Entity Type:Individual
Prefix:
First Name:VINESHIA
Middle Name:LASHELL
Last Name:WHITAKER
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 1:700 SW 62ND BLVD APT C34
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2015
Mailing Address - Country:US
Mailing Address - Phone:352-514-9080
Mailing Address - Fax:
Practice Address - Street 1:700 SW 62ND BLVD APT C34
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2015
Practice Address - Country:US
Practice Address - Phone:352-514-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor