Provider Demographics
NPI:1619400512
Name:CRUICKSHANK, MAKINI
Entity Type:Individual
Prefix:
First Name:MAKINI
Middle Name:
Last Name:CRUICKSHANK
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 1:1431 E 108TH ST
Mailing Address - Street 2:APT D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4666
Mailing Address - Country:US
Mailing Address - Phone:407-920-1761
Mailing Address - Fax:
Practice Address - Street 1:1431 E 108TH ST
Practice Address - Street 2:APT D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4666
Practice Address - Country:US
Practice Address - Phone:407-920-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002960-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer