Provider Demographics
NPI:1902464407
Name:HALL, SHENIQUA (MASTER HERBALIST)
Entity Type:Individual
Prefix:
First Name:SHENIQUA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MASTER HERBALIST
Other - Prefix:
Other - First Name:AUSET
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REIKI MASTER
Mailing Address - Street 1:505 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2807
Mailing Address - Country:US
Mailing Address - Phone:229-364-2721
Mailing Address - Fax:
Practice Address - Street 1:3205 SYLVESTER HWY
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-6451
Practice Address - Country:US
Practice Address - Phone:229-364-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner