Provider Demographics
NPI:1699363077
Name:SCOTT, SHAKIAH LATRECE
Entity Type:Individual
Prefix:
First Name:SHAKIAH
Middle Name:LATRECE
Last Name:SCOTT
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 1:2750 E W T HARRIS BLVD STE 237
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4373
Mailing Address - Country:US
Mailing Address - Phone:704-430-6228
Mailing Address - Fax:
Practice Address - Street 1:2750 E W T HARRIS BLVD STE 237
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4373
Practice Address - Country:US
Practice Address - Phone:704-430-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies