Provider Demographics
NPI:1538779160
Name:MILLIGAN, SHANETTA VALERIE
Entity type:Individual
Prefix:
First Name:SHANETTA
Middle Name:VALERIE
Last Name:MILLIGAN
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 1:4109 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6832
Mailing Address - Country:US
Mailing Address - Phone:202-409-7367
Mailing Address - Fax:
Practice Address - Street 1:248 14TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6408
Practice Address - Country:US
Practice Address - Phone:202-547-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant