Provider Demographics
NPI:1851533897
Name:WATKINS, SHYBRIA ALEXIS
Entity Type:Individual
Prefix:MRS
First Name:SHYBRIA
Middle Name:ALEXIS
Last Name:WATKINS
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 1:5409 RED FORK LN
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-6874
Mailing Address - Country:US
Mailing Address - Phone:843-737-3768
Mailing Address - Fax:843-760-9295
Practice Address - Street 1:5409 RED FORK LN
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-6874
Practice Address - Country:US
Practice Address - Phone:843-737-3768
Practice Address - Fax:843-760-9295
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies