Provider Demographics
NPI:1356032924
Name:BRIGGS DUBOSE, SHANIQUA DELIA
Entity type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:DELIA
Last Name:BRIGGS DUBOSE
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 1:2602 BRINKLEY RD APT 712
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1916
Mailing Address - Country:US
Mailing Address - Phone:202-200-8107
Mailing Address - Fax:
Practice Address - Street 1:2602 BRINKLEY RD APT 712
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-1916
Practice Address - Country:US
Practice Address - Phone:202-200-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty