Provider Demographics
NPI:1962791129
Name:MARSHALL, SHANQUAL KEONA
Entity type:Individual
Prefix:
First Name:SHANQUAL
Middle Name:KEONA
Last Name:MARSHALL
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 1:21 W ELLA J GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7003
Mailing Address - Country:US
Mailing Address - Phone:321-460-3731
Mailing Address - Fax:
Practice Address - Street 1:21 W ELLA J GILMORE ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7003
Practice Address - Country:US
Practice Address - Phone:321-460-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator