Provider Demographics
NPI:1043909344
Name:SMITH, SHAKERIA LASHAWNDA (LMT)
Entity Type:Individual
Prefix:
First Name:SHAKERIA
Middle Name:LASHAWNDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 CHUGACH WAY APT 209
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5786
Mailing Address - Country:US
Mailing Address - Phone:907-360-3089
Mailing Address - Fax:
Practice Address - Street 1:1381 CHUGACH WAY APT 209
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5786
Practice Address - Country:US
Practice Address - Phone:907-360-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK209392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist