Provider Demographics
NPI:1790124212
Name:STAPLES, SHANIQUA (BA)
Entity Type:Individual
Prefix:MS
First Name:SHANIQUA
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:SHANIQUA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:49 NEOME DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1133
Mailing Address - Country:US
Mailing Address - Phone:248-895-2998
Mailing Address - Fax:
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:STE. 100 SEMINOLE
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-451-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator