Provider Demographics
NPI:1235629494
Name:KEE, SHANERA
Entity Type:Individual
Prefix:
First Name:SHANERA
Middle Name:
Last Name:KEE
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 1:1216 ARCH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2835
Mailing Address - Country:US
Mailing Address - Phone:215-586-7605
Mailing Address - Fax:215-386-2604
Practice Address - Street 1:3600 MARKET ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2669
Practice Address - Country:US
Practice Address - Phone:215-586-7605
Practice Address - Fax:215-386-2604
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024869940001Medicaid