1689998916 NPI number — SHANEEKWA SHAUNTE PERKINS DPM

Table of content: SHANEEKWA SHAUNTE PERKINS DPM (NPI 1689998916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689998916 NPI number — SHANEEKWA SHAUNTE PERKINS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
SHANEEKWA
Provider Middle Name:
SHAUNTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERKINS
Provider Other First Name:
NIKKI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689998916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 WEST ST
Provider Second Line Business Mailing Address:
UNIT 7
Provider Business Mailing Address City Name:
WEST HATFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01088-9554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-397-8900
Provider Business Mailing Address Fax Number:
413-247-6151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 WEST ST
Provider Second Line Business Practice Location Address:
UNIT 7
Provider Business Practice Location Address City Name:
WEST HATFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01088-9554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-397-8900
Provider Business Practice Location Address Fax Number:
413-247-6151
Provider Enumeration Date:
03/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: LL9564 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: PD2394 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)