Provider Demographics
NPI:1871979542
Name:HOLIDAY, SHENIKO
Entity type:Individual
Prefix:
First Name:SHENIKO
Middle Name:
Last Name:HOLIDAY
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 1:911 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3062
Mailing Address - Country:US
Mailing Address - Phone:269-290-9787
Mailing Address - Fax:269-459-6454
Practice Address - Street 1:911 WASHINGTON AVE
Practice Address - Street 2:1703 RACE ST
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3062
Practice Address - Country:US
Practice Address - Phone:269-290-9787
Practice Address - Fax:269-459-6454
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health