Provider Demographics
NPI:1922641166
Name:WATSON, SHAQUEL RASHEY (RN, LMBT)
Entity Type:Individual
Prefix:MS
First Name:SHAQUEL
Middle Name:RASHEY
Last Name:WATSON
Suffix:
Gender:F
Credentials:RN, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WOODFIELD CREEK DR APT 212
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4761
Mailing Address - Country:US
Mailing Address - Phone:267-980-4261
Mailing Address - Fax:
Practice Address - Street 1:117 BROOKS ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2701
Practice Address - Country:US
Practice Address - Phone:919-307-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist