Provider Demographics
NPI:1508458183
Name:SHANKMAN, LILLIAN NAOMI
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:NAOMI
Last Name:SHANKMAN
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 1:1816 PIEDMONT HILLS PL APT 3111
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6680
Mailing Address - Country:US
Mailing Address - Phone:571-271-4871
Mailing Address - Fax:
Practice Address - Street 1:420 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2312
Practice Address - Country:US
Practice Address - Phone:571-271-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC106S00000XOtherABA