Provider Demographics
NPI:1063109767
Name:CATER, SHADELL (RDMS,RVT)
Entity type:Individual
Prefix:
First Name:SHADELL
Middle Name:
Last Name:CATER
Suffix:
Gender:F
Credentials:RDMS,RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 SWINNEA RD BLDG B2
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6361
Mailing Address - Country:US
Mailing Address - Phone:662-612-4658
Mailing Address - Fax:
Practice Address - Street 1:7165 SWINNEA RD BLDG B2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6361
Practice Address - Country:US
Practice Address - Phone:662-612-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2127972085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty