Provider Demographics
NPI:1801360680
Name:SOANES, SHANEL ALYSHA
Entity Type:Individual
Prefix:
First Name:SHANEL
Middle Name:ALYSHA
Last Name:SOANES
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 1:5005 ROUNDSTONE WAY APT 13
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1933
Mailing Address - Country:US
Mailing Address - Phone:704-790-9701
Mailing Address - Fax:
Practice Address - Street 1:1401 E 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-6301
Practice Address - Country:US
Practice Address - Phone:704-461-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician