Provider Demographics
NPI:1154031318
Name:DUCKETT, SHAFRON LAMONT
Entity type:Individual
Prefix:
First Name:SHAFRON
Middle Name:LAMONT
Last Name:DUCKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HICKORY GLN
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-7952
Mailing Address - Country:US
Mailing Address - Phone:256-513-2633
Mailing Address - Fax:
Practice Address - Street 1:103 HICKORY GLN
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-7952
Practice Address - Country:US
Practice Address - Phone:256-513-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6912529347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle