Provider Demographics
NPI:1558869685
Name:WIGGINS, SHAKIMA (CNM, IBCLC, LCCE)
Entity Type:Individual
Prefix:
First Name:SHAKIMA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:CNM, IBCLC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 ROCKAWAY PKWY APT D9
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3207
Mailing Address - Country:US
Mailing Address - Phone:718-541-7252
Mailing Address - Fax:
Practice Address - Street 1:488 ROCKAWAY PKWY APT D9
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3207
Practice Address - Country:US
Practice Address - Phone:718-541-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635827163WL0100X
NYF001893176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant