Provider Demographics
NPI:1194481820
Name:HAMMONDS, SHAQUAN
Entity type:Individual
Prefix:
First Name:SHAQUAN
Middle Name:
Last Name:HAMMONDS
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 1:41 RENZA LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1679
Mailing Address - Country:US
Mailing Address - Phone:914-620-7512
Mailing Address - Fax:
Practice Address - Street 1:41 RENZA LN
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1679
Practice Address - Country:US
Practice Address - Phone:914-620-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency