Provider Demographics
NPI:1245874700
Name:HUGHES, SHANTAE SHARIE (MT)
Entity type:Individual
Prefix:
First Name:SHANTAE
Middle Name:SHARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 ARKANSAS VALLEY DR STE 602
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4145
Mailing Address - Country:US
Mailing Address - Phone:501-319-2997
Mailing Address - Fax:
Practice Address - Street 1:2024 ARKANSAS VALLEY DR STE 602
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4145
Practice Address - Country:US
Practice Address - Phone:501-319-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist