Provider Demographics
NPI:1174303861
Name:SA-SHIQ LLC
Entity type:Organization
Organization Name:SA-SHIQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:704-893-2008
Mailing Address - Street 1:3800 MEETING ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28079-6582
Mailing Address - Country:US
Mailing Address - Phone:704-893-2008
Mailing Address - Fax:
Practice Address - Street 1:3800 MEETING ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:NC
Practice Address - Zip Code:28079-6582
Practice Address - Country:US
Practice Address - Phone:704-893-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty