Provider Demographics
NPI:1962227579
Name:ASHMORE, SHAQUETA L
Entity type:Individual
Prefix:
First Name:SHAQUETA
Middle Name:L
Last Name:ASHMORE
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 1:24007 TROWBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5425
Mailing Address - Country:US
Mailing Address - Phone:334-439-9254
Mailing Address - Fax:
Practice Address - Street 1:24007 TROWBRIDGE CT
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5425
Practice Address - Country:US
Practice Address - Phone:334-439-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician