Provider Demographics
NPI:1346972643
Name:BANKS, SHANIEAH SIMONE
Entity Type:Individual
Prefix:
First Name:SHANIEAH
Middle Name:SIMONE
Last Name:BANKS
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 1:11361 W PEREGRINE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3151
Mailing Address - Country:US
Mailing Address - Phone:414-213-4956
Mailing Address - Fax:
Practice Address - Street 1:11361 W PEREGRINE WAY
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3151
Practice Address - Country:US
Practice Address - Phone:414-213-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant