Healthcare Provider Details

I. General information

NPI: 1669310447
Provider Name (Legal Business Name): SHURITA LAFAYE ESAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SHADY OAKS CIR
MC GEHEE AR
71654-3517
US

IV. Provider business mailing address

403 SHADY OAKS CIR
MC GEHEE AR
71654-3517
US

V. Phone/Fax

Practice location:
  • Phone: 870-718-6935
  • Fax: 870-718-6935
Mailing address:
  • Phone: 870-718-6935
  • Fax: 870-718-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: