Provider Demographics
NPI:1396452199
Name:WHITE, SHYNDALE
Entity type:Individual
Prefix:
First Name:SHYNDALE
Middle Name:
Last Name:WHITE
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 1:723 ROSENWALD ST 3-7
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748-3173
Mailing Address - Country:US
Mailing Address - Phone:662-931-6012
Mailing Address - Fax:
Practice Address - Street 1:801 ROSENWALD ST # 19B
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MS
Practice Address - Zip Code:38748-3131
Practice Address - Country:US
Practice Address - Phone:662-931-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker