Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | TN |
NPI | 1457964850 |
---|---|
Provider Name | Shaquela L Sanford |
First Address | Chattanooga, TN 37411-3435 |
Second Address | Chattanooga, TN 37411-3435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2020 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1744P3200X | (05) | TN |