Provider Demographics
NPI:1265028153
Name:HARRIS, SHANIKA N
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:N
Last Name:HARRIS
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 1:2086 SE TRIUMPH RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4867
Mailing Address - Country:US
Mailing Address - Phone:772-361-4519
Mailing Address - Fax:
Practice Address - Street 1:2086 SE TRIUMPH RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4867
Practice Address - Country:US
Practice Address - Phone:772-361-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities