Provider Demographics
NPI:1538780614
Name:FLETCHER-YORK, SHANEQUAL
Entity type:Individual
Prefix:MRS
First Name:SHANEQUAL
Middle Name:
Last Name:FLETCHER-YORK
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 1:319 N OAKLEY DR APT 21
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-6651
Mailing Address - Country:US
Mailing Address - Phone:706-510-9797
Mailing Address - Fax:
Practice Address - Street 1:319 N OAKLEY DR APT 21
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-6651
Practice Address - Country:US
Practice Address - Phone:706-510-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor