Provider Demographics
NPI:1588362305
Name:DORROUGH, SHUNTA
Entity type:Individual
Prefix:
First Name:SHUNTA
Middle Name:
Last Name:DORROUGH
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 1:1100 MEREDITH LN APT 1037
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4672
Mailing Address - Country:US
Mailing Address - Phone:469-682-8787
Mailing Address - Fax:
Practice Address - Street 1:1100 MEREDITH LN APT 1037
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4672
Practice Address - Country:US
Practice Address - Phone:469-682-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist