Provider Demographics
NPI:1467165027
Name:SHAKA, DONTE
Entity Type:Individual
Prefix:MS
First Name:DONTE
Middle Name:
Last Name:SHAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17823 RAULAND DR
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5103
Mailing Address - Country:US
Mailing Address - Phone:216-832-0190
Mailing Address - Fax:
Practice Address - Street 1:17823 RAULAND DR
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-5103
Practice Address - Country:US
Practice Address - Phone:216-832-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program