Provider Demographics
NPI:1376209031
Name:FARMER, SHANTA KITT
Entity Type:Individual
Prefix:
First Name:SHANTA
Middle Name:KITT
Last Name:FARMER
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 1:4025 COLLEGIATE AVE APT D1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8173
Mailing Address - Country:US
Mailing Address - Phone:704-361-0851
Mailing Address - Fax:
Practice Address - Street 1:4025 COLLEGIATE AVE APT D1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8173
Practice Address - Country:US
Practice Address - Phone:704-361-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare