Provider Demographics
NPI:1255875688
Name:MULLANY, SHA'QUICE
Entity type:Individual
Prefix:
First Name:SHA'QUICE
Middle Name:
Last Name:MULLANY
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 1:715 N CONGRESS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4743
Mailing Address - Country:US
Mailing Address - Phone:231-818-2717
Mailing Address - Fax:
Practice Address - Street 1:715 N CONGRESS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4743
Practice Address - Country:US
Practice Address - Phone:231-818-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other