Provider Demographics
NPI:1508691999
Name:MCKENZIE, RACQUEL SHARANDO (RMA)
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:SHARANDO
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ELLIPTIC GREEN LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7057
Mailing Address - Country:US
Mailing Address - Phone:317-797-7188
Mailing Address - Fax:
Practice Address - Street 1:315 MARBLE RD
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:ST. JAMES
Practice Address - Zip Code:JMDCN09
Practice Address - Country:JM
Practice Address - Phone:317-755-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service