Provider Demographics
NPI:1497518039
Name:SHANKS, IBERIKA J
Entity Type:Individual
Prefix:
First Name:IBERIKA
Middle Name:J
Last Name:SHANKS
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 1:819 W BEACON RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2846
Mailing Address - Country:US
Mailing Address - Phone:863-618-8241
Mailing Address - Fax:
Practice Address - Street 1:819 W BEACON RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2846
Practice Address - Country:US
Practice Address - Phone:863-618-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst