Provider Demographics
NPI:1801346291
Name:WALCOTT, SHANICE (DO, MPH)
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9619 MAXSON DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6974
Mailing Address - Country:US
Mailing Address - Phone:813-951-6269
Mailing Address - Fax:
Practice Address - Street 1:1977 BUTLER BLVD STE E4.400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-4857
Practice Address - Fax:713-798-3465
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician