Provider Demographics
NPI:1306439328
Name:SCREEN, SHAQUIRAH LASHEA
Entity type:Individual
Prefix:
First Name:SHAQUIRAH
Middle Name:LASHEA
Last Name:SCREEN
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 1:925 S WEST ST APT B
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4530
Mailing Address - Country:US
Mailing Address - Phone:229-205-5032
Mailing Address - Fax:
Practice Address - Street 1:925 S WEST ST # ATB
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4519
Practice Address - Country:US
Practice Address - Phone:229-205-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059851617OtherID
GA049851617OtherDL