Healthcare Provider Details

I. General information

NPI: 1295647600
Provider Name (Legal Business Name): SHANIQUE BECKFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HOWMET DR STE A
HAMPTON VA
23661-1001
US

IV. Provider business mailing address

701 HOWMET DR STE A
HAMPTON VA
23661-1001
US

V. Phone/Fax

Practice location:
  • Phone: 757-812-7420
  • Fax: 757-765-6109
Mailing address:
  • Phone: 757-812-7420
  • Fax: 757-765-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number764125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: