Provider Demographics
NPI:1689456758
Name:BROOKS, SHASHA LETRICE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHASHA
Middle Name:LETRICE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E 59TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2657
Mailing Address - Country:US
Mailing Address - Phone:219-955-1092
Mailing Address - Fax:
Practice Address - Street 1:5490 BROADWAY STE L-6
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1663
Practice Address - Country:US
Practice Address - Phone:219-779-8893
Practice Address - Fax:219-874-1682
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician