Provider Demographics
NPI:1700343316
Name:CHESTNUT, SHACREE
Entity Type:Individual
Prefix:
First Name:SHACREE
Middle Name:
Last Name:CHESTNUT
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 1:129 QUINN CIR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1739
Mailing Address - Country:US
Mailing Address - Phone:410-725-1904
Mailing Address - Fax:
Practice Address - Street 1:1919 WEST ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3954
Practice Address - Country:US
Practice Address - Phone:410-656-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician