Provider Demographics
NPI:1356102958
Name:SCURLOCK, CHANDA LATOYA
Entity type:Individual
Prefix:
First Name:CHANDA
Middle Name:LATOYA
Last Name:SCURLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANDA
Other - Middle Name:
Other - Last Name:SCURLOCK-SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16635 SPRING CYPRESS RD # 445
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1713
Mailing Address - Country:US
Mailing Address - Phone:346-379-7474
Mailing Address - Fax:346-895-0048
Practice Address - Street 1:16635 SPRING CYPRESS RD # 445
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1713
Practice Address - Country:US
Practice Address - Phone:346-379-7474
Practice Address - Fax:346-895-0048
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)