Provider Demographics
NPI:1336966787
Name:PRESTON, SHAQUANDA
Entity type:Individual
Prefix:
First Name:SHAQUANDA
Middle Name:
Last Name:PRESTON
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 1:188 MEMORIAL PKWY # 188
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4259
Mailing Address - Country:US
Mailing Address - Phone:862-202-0379
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2369
Practice Address - Country:US
Practice Address - Phone:973-310-6998
Practice Address - Fax:201-502-8711
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy