Provider Demographics
NPI:1730837758
Name:MCCALL, SHANIKA (MEDICAL TATTOO)
Entity type:Individual
Prefix:
First Name:SHANIKA
Middle Name:
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MEDICAL TATTOO
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:
Other - Last Name:LUXXE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:184 HUNTLEY CT
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2276
Mailing Address - Country:US
Mailing Address - Phone:702-843-4459
Mailing Address - Fax:
Practice Address - Street 1:500 N REILLY RD STE 122
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2452
Practice Address - Country:US
Practice Address - Phone:910-988-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5026611640246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Multi-Specialty