Provider Demographics
NPI:1801692587
Name:EDWARDS, SHANTICE
Entity type:Individual
Prefix:
First Name:SHANTICE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 WEBSTER ST APT 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3440
Mailing Address - Country:US
Mailing Address - Phone:912-572-4763
Mailing Address - Fax:
Practice Address - Street 1:1732 WEBSTER ST APT 304
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3440
Practice Address - Country:US
Practice Address - Phone:912-572-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula