Provider Demographics
NPI:1134376437
Name:NUNAG, SHAKESPEARE S (P,T,)
Entity type:Individual
Prefix:
First Name:SHAKESPEARE
Middle Name:S
Last Name:NUNAG
Suffix:
Gender:M
Credentials:P,T,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 SHERATON PARK DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6872
Mailing Address - Country:US
Mailing Address - Phone:870-671-4412
Mailing Address - Fax:
Practice Address - Street 1:2915 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5008
Practice Address - Country:US
Practice Address - Phone:870-535-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist