Healthcare Provider Details

I. General information

NPI: 1770419178
Provider Name (Legal Business Name): SHANALE LOCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 BROADWAY APT 9
RIVIERA BEACH FL
33404-2307
US

IV. Provider business mailing address

2820 BROADWAY APT 9
RIVIERA BEACH FL
33404-2307
US

V. Phone/Fax

Practice location:
  • Phone: 561-720-9127
  • Fax:
Mailing address:
  • Phone: 561-720-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC32933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: