Provider Demographics
NPI:1609587583
Name:WALKER, SHENAE MONIQUE
Entity type:Individual
Prefix:MRS
First Name:SHENAE
Middle Name:MONIQUE
Last Name:WALKER
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 1:7400 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4644
Mailing Address - Country:US
Mailing Address - Phone:843-572-0275
Mailing Address - Fax:843-572-0395
Practice Address - Street 1:7400 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4644
Practice Address - Country:US
Practice Address - Phone:843-572-0275
Practice Address - Fax:843-572-0395
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1335156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician