Provider Demographics
NPI:1629949292
Name:PHILLIPS, NEQUAN SHAQUILLE
Entity type:Individual
Prefix:MR
First Name:NEQUAN
Middle Name:SHAQUILLE
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13259 SW 286TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7548
Mailing Address - Country:US
Mailing Address - Phone:407-492-1841
Mailing Address - Fax:
Practice Address - Street 1:12350 SW 132ND CT STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6458
Practice Address - Country:US
Practice Address - Phone:786-732-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1194284106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty