Provider Demographics
NPI:1649876954
Name:BEVERLY, SHANEKA CHANTEL
Entity type:Individual
Prefix:
First Name:SHANEKA
Middle Name:CHANTEL
Last Name:BEVERLY
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 1:772 KENILWORTH TER NE APT 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1861
Mailing Address - Country:US
Mailing Address - Phone:202-749-1887
Mailing Address - Fax:
Practice Address - Street 1:502 M ST NW APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3663
Practice Address - Country:US
Practice Address - Phone:202-702-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant