Provider Demographics
NPI:1124629134
Name:RAINES, SHAMEKA ASHAWN
Entity type:Individual
Prefix:MRS
First Name:SHAMEKA
Middle Name:ASHAWN
Last Name:RAINES
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 1:111 N BAY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1431
Mailing Address - Country:US
Mailing Address - Phone:850-899-0599
Mailing Address - Fax:
Practice Address - Street 1:111 N BAY ST
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1431
Practice Address - Country:US
Practice Address - Phone:850-899-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care