Provider Demographics
NPI:1265002158
Name:NORFLEET, SHAKUR KEYONIA
Entity Type:Individual
Prefix:
First Name:SHAKUR
Middle Name:KEYONIA
Last Name:NORFLEET
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 1:231 S FULTON AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-5155
Mailing Address - Country:US
Mailing Address - Phone:646-573-5834
Mailing Address - Fax:
Practice Address - Street 1:231 S FULTON AVE APT 3A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-5155
Practice Address - Country:US
Practice Address - Phone:646-573-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty