Individual
SHUNTAK JERIDEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 N WESTMORELAND RD, DALLAS, TX 75211-1654
(214) 330-0036
Mailing address
1350 N WESTMORELAND RD, DALLAS, TX 75211
(214) 330-0036
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
734308
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP140554
TX
Other
Enumeration date
09/24/2010
Last updated
08/11/2019
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