Provider Demographics
NPI:1679752091
Name:PRYOR, SHAMIKA SHARNELL
Entity type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:SHARNELL
Last Name:PRYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 SURREY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2136
Mailing Address - Country:US
Mailing Address - Phone:240-351-2747
Mailing Address - Fax:
Practice Address - Street 1:389 SURREY CLUB LN
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2136
Practice Address - Country:US
Practice Address - Phone:240-351-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program