Provider Demographics
NPI:1124347588
Name:PRICE, SHANEAKA LATISHA (CERT HAIR LOSS SPEC)
Entity type:Individual
Prefix:MS
First Name:SHANEAKA
Middle Name:LATISHA
Last Name:PRICE
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 HUSTINGS COURT LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2842
Mailing Address - Country:US
Mailing Address - Phone:757-560-0873
Mailing Address - Fax:
Practice Address - Street 1:481B S LYNNHAVEN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6600
Practice Address - Country:US
Practice Address - Phone:757-431-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12040185461744P3200X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist