Provider Demographics
NPI:1710779327
Name:JACQUES, SHAQUIRAH SELINA (CPT)
Entity type:Individual
Prefix:
First Name:SHAQUIRAH
Middle Name:SELINA
Last Name:JACQUES
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 WATER OAK DR.
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9544
Mailing Address - Country:US
Mailing Address - Phone:984-222-4054
Mailing Address - Fax:
Practice Address - Street 1:356 WATER OAK DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9544
Practice Address - Country:US
Practice Address - Phone:984-222-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 246W00000X, 372600000X, 3747P1801X
NC0587-21246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No174400000XOther Service ProvidersSpecialist
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant