Provider Demographics
NPI:1447796917
Name:BARNER, SHAKESHA (STNA)
Entity Type:Individual
Prefix:
First Name:SHAKESHA
Middle Name:
Last Name:BARNER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068
Mailing Address - Country:US
Mailing Address - Phone:614-382-9271
Mailing Address - Fax:
Practice Address - Street 1:6520 BENJAMIN DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3902
Practice Address - Country:US
Practice Address - Phone:624-382-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401649130514171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications