Provider Demographics
NPI:1609680792
Name:PICKENS, SHAMON DAVIS
Entity type:Individual
Prefix:MRS
First Name:SHAMON
Middle Name:DAVIS
Last Name:PICKENS
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 1:459 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4912
Mailing Address - Country:US
Mailing Address - Phone:405-513-0291
Mailing Address - Fax:
Practice Address - Street 1:459 N GROVE ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4912
Practice Address - Country:US
Practice Address - Phone:405-513-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty