Provider Demographics
NPI:1699543827
Name:GLENN, SHAQUANA SHANICE
Entity type:Individual
Prefix:MRS
First Name:SHAQUANA
Middle Name:SHANICE
Last Name:GLENN
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 1:219 W MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3232
Mailing Address - Country:US
Mailing Address - Phone:704-906-8458
Mailing Address - Fax:
Practice Address - Street 1:3700 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-7534
Practice Address - Country:US
Practice Address - Phone:704-906-8458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist