Provider Demographics
NPI:1710345566
Name:TAKAGI, SHIGEKO
Entity Type:Individual
Prefix:
First Name:SHIGEKO
Middle Name:
Last Name:TAKAGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIGEKO
Other - Middle Name:
Other - Last Name:ION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6653 71ST ST
Mailing Address - Street 2:APT 2D
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2153
Mailing Address - Country:US
Mailing Address - Phone:347-988-6677
Mailing Address - Fax:
Practice Address - Street 1:6653 71ST ST
Practice Address - Street 2:APT 2D
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2153
Practice Address - Country:US
Practice Address - Phone:347-988-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY710078-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health