Provider Demographics
NPI:1568713568
Name:HEYWARD, SHAUNDREIKA (MHP)
Entity type:Individual
Prefix:
First Name:SHAUNDREIKA
Middle Name:
Last Name:HEYWARD
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3769 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-1303
Mailing Address - Country:US
Mailing Address - Phone:803-318-3861
Mailing Address - Fax:
Practice Address - Street 1:105 OTIS SMITH DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8940
Practice Address - Country:US
Practice Address - Phone:931-320-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3686101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator