Provider Demographics
NPI:1770100109
Name:TATE, SHANTERIKA
Entity type:Individual
Prefix:MS
First Name:SHANTERIKA
Middle Name:
Last Name:TATE
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 1:5407 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-4543
Mailing Address - Country:US
Mailing Address - Phone:228-205-8303
Mailing Address - Fax:
Practice Address - Street 1:5407 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-4543
Practice Address - Country:US
Practice Address - Phone:228-205-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker