Provider Demographics
NPI:1639528839
Name:SHANKS, RACHEL (MEDL, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:SHANKS
Suffix:
Gender:F
Credentials:MEDL, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CRYSTAL SPRING FARM RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1001
Mailing Address - Country:US
Mailing Address - Phone:484-252-6076
Mailing Address - Fax:
Practice Address - Street 1:911 CRYSTAL SPRING FARM RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1001
Practice Address - Country:US
Practice Address - Phone:484-252-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00709207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine