Provider Demographics
NPI:1689056616
Name:SINGLETARY, SHANDER
Entity Type:Individual
Prefix:
First Name:SHANDER
Middle Name:
Last Name:SINGLETARY
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 1:9608 57TH AVE
Mailing Address - Street 2:APT 7-M
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3401
Mailing Address - Country:US
Mailing Address - Phone:347-531-9631
Mailing Address - Fax:
Practice Address - Street 1:9608 57TH AVE
Practice Address - Street 2:APT 7-M
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3401
Practice Address - Country:US
Practice Address - Phone:347-531-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist