Provider Demographics
NPI:1710309885
Name:DAILEY, SHUNTA
Entity Type:Individual
Prefix:
First Name:SHUNTA
Middle Name:
Last Name:DAILEY
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 1:110 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6129
Mailing Address - Country:US
Mailing Address - Phone:979-297-3802
Mailing Address - Fax:979-297-3993
Practice Address - Street 1:110 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6129
Practice Address - Country:US
Practice Address - Phone:979-297-3802
Practice Address - Fax:979-297-3993
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator