Provider Demographics
NPI:1679721039
Name:WHITE, SHUNAKA GRAYSON (OTR/L, CAPS, ECHM)
Entity type:Individual
Prefix:MRS
First Name:SHUNAKA
Middle Name:GRAYSON
Last Name:WHITE
Suffix:
Gender:
Credentials:OTR/L, CAPS, ECHM
Other - Prefix:MS
Other - First Name:SHUNAKA
Other - Middle Name:TRENISE
Other - Last Name:GRAYSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, CAPS, ECHM
Mailing Address - Street 1:532 GLADIOLA WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6848
Mailing Address - Country:US
Mailing Address - Phone:202-696-0634
Mailing Address - Fax:540-657-3664
Practice Address - Street 1:532 GLADIOLA WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6848
Practice Address - Country:US
Practice Address - Phone:202-696-0634
Practice Address - Fax:540-657-3664
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006450225X00000X
TN3551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist