Provider Demographics
NPI:1598558223
Name:PAULING GRAY, SHAQUANA L
Entity type:Individual
Prefix:
First Name:SHAQUANA
Middle Name:L
Last Name:PAULING GRAY
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 1:414 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4026
Mailing Address - Country:US
Mailing Address - Phone:803-410-8280
Mailing Address - Fax:
Practice Address - Street 1:414 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4026
Practice Address - Country:US
Practice Address - Phone:803-410-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100538891343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)