Provider Demographics
NPI:1932719903
Name:RILEY, SHAQUITA M
Entity Type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAQUITA
Other - Middle Name:M
Other - Last Name:WHITTENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:468 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-4710
Mailing Address - Country:US
Mailing Address - Phone:504-406-5592
Mailing Address - Fax:
Practice Address - Street 1:733 DANTE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1013
Practice Address - Country:US
Practice Address - Phone:504-517-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst