Provider Demographics
NPI:1881188787
Name:WASHINGTON, SHANDRIKA DANNAE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:SHANDRIKA
Middle Name:DANNAE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 GABLE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6465
Mailing Address - Country:US
Mailing Address - Phone:404-988-7903
Mailing Address - Fax:
Practice Address - Street 1:5400 RIVERSTATION BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5303
Practice Address - Country:US
Practice Address - Phone:404-761-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management