1992377295 NPI number — MISS SHAQUALA LECHELLE PRICE LPTA

Table of content: MISS SHAQUALA LECHELLE PRICE LPTA (NPI 1992377295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992377295 NPI number — MISS SHAQUALA LECHELLE PRICE LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
SHAQUALA
Provider Middle Name:
LECHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE
Provider Other First Name:
SHAQUALA
Provider Other Middle Name:
LECHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPTA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992377295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
764 INTERNATIONAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024-3585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-456-3764
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2277 CHESTNUT RIDGE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-412-5256
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  2155619 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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