Provider Demographics
NPI:1982570859
Name:MCDONALD, JAQUARA SHADAE
Entity type:Individual
Prefix:
First Name:JAQUARA
Middle Name:SHADAE
Last Name:MCDONALD
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 1:3380 ALPENGLOW DR
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-8001
Mailing Address - Country:US
Mailing Address - Phone:803-486-9383
Mailing Address - Fax:
Practice Address - Street 1:900 TRAIL RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7765
Practice Address - Country:US
Practice Address - Phone:571-464-4299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician