Provider Demographics
NPI:1811610256
Name:CATTLING, SHAQUILLE
Entity type:Individual
Prefix:
First Name:SHAQUILLE
Middle Name:
Last Name:CATTLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N 190TH AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-5726
Mailing Address - Country:US
Mailing Address - Phone:256-485-2058
Mailing Address - Fax:
Practice Address - Street 1:131 N 190TH AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5726
Practice Address - Country:US
Practice Address - Phone:256-485-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician