Provider Demographics
NPI:1972164846
Name:NGOM, SHANEKA S
Entity type:Individual
Prefix:
First Name:SHANEKA
Middle Name:S
Last Name:NGOM
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 1:4548 BRISCOE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-2008
Mailing Address - Country:US
Mailing Address - Phone:832-343-0665
Mailing Address - Fax:
Practice Address - Street 1:4606 WHITE ROCK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-2044
Practice Address - Country:US
Practice Address - Phone:832-343-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health