Provider Demographics
NPI:1851862635
Name:HENDERSON, SHONQUELL S
Entity Type:Individual
Prefix:MS
First Name:SHONQUELL
Middle Name:S
Last Name:HENDERSON
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 1:2418 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3318
Mailing Address - Country:US
Mailing Address - Phone:267-257-9386
Mailing Address - Fax:
Practice Address - Street 1:6637 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2618
Practice Address - Country:US
Practice Address - Phone:267-257-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health