Healthcare Provider Details

I. General information

NPI: 1598386799
Provider Name (Legal Business Name): SHANEKA DASHUNE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 09/30/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 LOCUST DR
JONESBORO AR
72401-7012
US

IV. Provider business mailing address

732 LOCUST DR
JONESBORO AR
72401-7012
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-9575
  • Fax:
Mailing address:
  • Phone: 870-243-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: