Provider Demographics
NPI:1841620903
Name:SHORTTE, SHAVICA
Entity type:Individual
Prefix:
First Name:SHAVICA
Middle Name:
Last Name:SHORTTE
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 1:1695 MAIN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1348
Mailing Address - Country:US
Mailing Address - Phone:413-739-5572
Mailing Address - Fax:413-739-9972
Practice Address - Street 1:143 WEST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3749
Practice Address - Country:US
Practice Address - Phone:413-586-8213
Practice Address - Fax:413-585-9139
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility