Provider Demographics
NPI:1851181770
Name:DURHAM, SHANIQUA
Entity type:Individual
Prefix:MS
First Name:SHANIQUA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MYA
Other - Middle Name:
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 MACKENAN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6498
Mailing Address - Country:US
Mailing Address - Phone:919-298-1306
Mailing Address - Fax:
Practice Address - Street 1:201 MACKENAN DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6498
Practice Address - Country:US
Practice Address - Phone:919-298-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician