Provider Demographics
NPI:1144900010
Name:STANCIL, SHANICE
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
Last Name:STANCIL
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 1:3210 63RD PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-4059
Mailing Address - Country:US
Mailing Address - Phone:601-917-3104
Mailing Address - Fax:
Practice Address - Street 1:3210 63RD PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-4059
Practice Address - Country:US
Practice Address - Phone:601-917-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program