Provider Demographics
NPI:1548963473
Name:FERNANDEZ, SHAMIKA LASHONDA
Entity type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:LASHONDA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAMIKA
Other - Middle Name:LASHONDA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1635
Mailing Address - Country:US
Mailing Address - Phone:904-652-5916
Mailing Address - Fax:
Practice Address - Street 1:702 CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-1635
Practice Address - Country:US
Practice Address - Phone:904-652-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor