Provider Demographics
NPI:1881280840
Name:MCRAE, SHATIGRA
Entity type:Individual
Prefix:
First Name:SHATIGRA
Middle Name:
Last Name:MCRAE
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 1:3837 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6740
Mailing Address - Country:US
Mailing Address - Phone:407-717-3843
Mailing Address - Fax:
Practice Address - Street 1:3837 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6740
Practice Address - Country:US
Practice Address - Phone:407-717-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult Companion