Provider Demographics
NPI:1437823101
Name:HAMILTON, SHAKEISHA MONIQUE'
Entity Type:Individual
Prefix:
First Name:SHAKEISHA
Middle Name:MONIQUE'
Last Name:HAMILTON
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 1:80 FURMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-4502
Mailing Address - Country:US
Mailing Address - Phone:203-715-9707
Mailing Address - Fax:
Practice Address - Street 1:80 FURMAN RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-4502
Practice Address - Country:US
Practice Address - Phone:203-715-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT374J00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical