Provider Demographics
NPI:1144045238
Name:PUJOUE, SHANE'JA JUANAE
Entity type:Individual
Prefix:
First Name:SHANE'JA
Middle Name:JUANAE
Last Name:PUJOUE
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 1:151 CHAMPIONS VUE LOOP UNIT 407
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-4846
Mailing Address - Country:US
Mailing Address - Phone:240-346-3767
Mailing Address - Fax:
Practice Address - Street 1:151 CHAMPIONS VUE LOOP UNIT 407
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-4846
Practice Address - Country:US
Practice Address - Phone:240-346-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator