Healthcare Provider Details

I. General information

NPI: 1891466231
Provider Name (Legal Business Name): SHAKETA S WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BENTON AVE UNIT 315
NASHVILLE TN
37204-2684
US

IV. Provider business mailing address

445 BENTON AVE UNIT 315
NASHVILLE TN
37204-2684
US

V. Phone/Fax

Practice location:
  • Phone: 615-364-9732
  • Fax:
Mailing address:
  • Phone: 615-364-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number091851776
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number091851776
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number091581776
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: