Provider Demographics
NPI:1821735853
Name:SPRINKLE, SHAQUOIA
Entity Type:Individual
Prefix:
First Name:SHAQUOIA
Middle Name:
Last Name:SPRINKLE
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 1:4930 HOLLY OAK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8903
Mailing Address - Country:US
Mailing Address - Phone:260-557-0019
Mailing Address - Fax:
Practice Address - Street 1:4930 HOLLY OAK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8903
Practice Address - Country:US
Practice Address - Phone:260-557-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN146N00000X
146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic