| Doctor Name: | MRS. SHAUNTAE MARIE DIXON |
| NPI Number: | 1346401957 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1728808 |
| Business Practice Address: | 23191 Lawrence St 23191 Lawrence St South Bend, IN - 466285250 |
| Business Phone Number: | 5742343107 |
| Business Fax Number: | 5742343107 |
| Mailing Address: | 23191 Lawrence St, 23191 Lawrence St SOUTH BEND |
| State: | IN |
| Postal Code: | 466285250 |
| Phone Number: | 5742343107 |
| Fax Number: | 5742343107 |
| NPI Enumeration Date: | 06/17/2008 |
| NPI Last Update Date: | 06/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 343900000X |
| License Number: | 1728808 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Non-emergency Medical Transport (VAN) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |