Provider Demographics
NPI:1376990374
Name:SHANKOFF, MINETTE
Entity Type:Individual
Prefix:MRS
First Name:MINETTE
Middle Name:
Last Name:SHANKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINETTE
Other - Middle Name:FERNANDEZ
Other - Last Name:AJIDO-SHANKOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19530 MT ZION PKWY
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8398
Mailing Address - Country:US
Mailing Address - Phone:704-997-2970
Mailing Address - Fax:
Practice Address - Street 1:19530 MT ZION PKWY
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8398
Practice Address - Country:US
Practice Address - Phone:704-997-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10474247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other