Healthcare Provider Details

I. General information

NPI: 1861303976
Provider Name (Legal Business Name): SHAUNDINE LEA DUNCAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 B VETERANS BLVD
ACOMA NM
87034
US

IV. Provider business mailing address

6732 VENTANA HILLS RD NW
ALBUQUERQUE NM
87114-2433
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5300
  • Fax:
Mailing address:
  • Phone: 505-552-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH3980
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: