Provider Demographics
NPI:1689998916
Name:PERKINS, SHANEEKWA SHAUNTE (DPM)
Entity Type:Individual
Prefix:
First Name:SHANEEKWA
Middle Name:SHAUNTE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:10 WEST ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:WEST HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01088-9554
Mailing Address - Country:US
Mailing Address - Phone:413-397-8900
Mailing Address - Fax:413-247-6151
Practice Address - Street 1:10 WEST ST
Practice Address - Street 2:UNIT 7
Practice Address - City:WEST HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01088-9554
Practice Address - Country:US
Practice Address - Phone:413-397-8900
Practice Address - Fax:413-247-6151
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA390200000X
MDLL9564213ES0103X
MAPD2394213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003240001Medicare PIN