Provider Demographics
NPI:1538842612
Name:AUGUSTINE, CHARMEKA JOANNETRA
Entity type:Individual
Prefix:
First Name:CHARMEKA
Middle Name:JOANNETRA
Last Name:AUGUSTINE
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 1:16742 SOUTHWEST FWY STE 44&45
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2331
Mailing Address - Country:US
Mailing Address - Phone:281-748-8633
Mailing Address - Fax:
Practice Address - Street 1:16742 SOUTHWEST FWY STE 44&45
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2331
Practice Address - Country:US
Practice Address - Phone:281-748-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier