Provider Demographics
NPI:1790524759
Name:WALKER, SHANIQUE
Entity type:Individual
Prefix:DR
First Name:SHANIQUE
Middle Name:
Last Name:WALKER
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:PO BOX 60976
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205-0976
Mailing Address - Country:US
Mailing Address - Phone:832-977-8047
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 60976
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77205-0976
Practice Address - Country:US
Practice Address - Phone:832-977-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC14128322D00000X, 405300000X, 171M00000X
322D00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No405300000XOther Service ProvidersPrevention Professional