Provider Demographics
NPI:1942699533
Name:CROMARTIE, SHANDRA
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:
Last Name:CROMARTIE
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 1:5452 HANOVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5968
Mailing Address - Country:US
Mailing Address - Phone:336-391-7393
Mailing Address - Fax:
Practice Address - Street 1:4651 SALISBURY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6107
Practice Address - Country:US
Practice Address - Phone:336-306-9417
Practice Address - Fax:336-306-9418
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator