Provider Demographics
NPI:1134000995
Name:RICHARDSON, SHANIYA
Entity type:Individual
Prefix:
First Name:SHANIYA
Middle Name:
Last Name:RICHARDSON
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 1:138 N CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1712
Mailing Address - Country:US
Mailing Address - Phone:252-908-0611
Mailing Address - Fax:
Practice Address - Street 1:138 N CLARENDON DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1712
Practice Address - Country:US
Practice Address - Phone:252-908-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC8090343900000X, 385HR2050X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp