Provider Demographics
NPI:1881490704
Name:BURRELL, SHAWANDA
Entity type:Individual
Prefix:
First Name:SHAWANDA
Middle Name:
Last Name:BURRELL
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 1:748 OLD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CATHERINE
Mailing Address - State:AL
Mailing Address - Zip Code:36728-3208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:748 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CATHERINE
Practice Address - State:AL
Practice Address - Zip Code:36728-3208
Practice Address - Country:US
Practice Address - Phone:334-327-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty