Provider Demographics
NPI:1508483207
Name:WOOTEN, SHAKIRA LASHAY
Entity Type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:LASHAY
Last Name:WOOTEN
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 1:5840 N CANTON CENTER RD STE 270
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2614
Mailing Address - Country:US
Mailing Address - Phone:734-366-1665
Mailing Address - Fax:
Practice Address - Street 1:5840 N CANTON CENTER RD STE 270
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2614
Practice Address - Country:US
Practice Address - Phone:734-366-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist