Provider Demographics
NPI:1245074558
Name:MCKENZIE, SHANOVIA
Entity type:Individual
Prefix:
First Name:SHANOVIA
Middle Name:
Last Name:MCKENZIE
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 1:9771 GOOD LUCK RD APT 7
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3334
Mailing Address - Country:US
Mailing Address - Phone:202-763-2195
Mailing Address - Fax:
Practice Address - Street 1:4715 FOOTE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4774
Practice Address - Country:US
Practice Address - Phone:202-397-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant