Provider Demographics
NPI:1225712755
Name:SHANKLIN ROBERTS, IMANI N
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:N
Last Name:SHANKLIN ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 W ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1068
Mailing Address - Country:US
Mailing Address - Phone:202-770-5426
Mailing Address - Fax:
Practice Address - Street 1:1600 MARYLAND AVE NE APT 418W
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7666
Practice Address - Country:US
Practice Address - Phone:202-770-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist