Provider Demographics
NPI:1720804990
Name:PACHECO, SHAUNTAE ARIETTE
Entity type:Individual
Prefix:
First Name:SHAUNTAE
Middle Name:ARIETTE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAUNTAE
Other - Middle Name:ARIETTE
Other - Last Name:FOOKS, CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1131 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-422-8026
Mailing Address - Fax:302-422-0701
Practice Address - Street 1:PEOPLE'S PLACE
Practice Address - Street 2:1131 AIRPORT ROAD
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-422-8026
Practice Address - Fax:302-422-0701
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health