Provider Demographics
NPI:1295407336
Name:BARAKA, SHASHU (BS)
Entity Type:Individual
Prefix:
First Name:SHASHU
Middle Name:
Last Name:BARAKA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1843
Mailing Address - Country:US
Mailing Address - Phone:269-459-4856
Mailing Address - Fax:269-342-4088
Practice Address - Street 1:1001 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1843
Practice Address - Country:US
Practice Address - Phone:269-459-4856
Practice Address - Fax:269-342-4088
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator