Provider Demographics
NPI:1710405048
Name:GILBERT, SHANNIKA
Entity Type:Individual
Prefix:MRS
First Name:SHANNIKA
Middle Name:
Last Name:GILBERT
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 1:12075 SORRENTO ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3751
Mailing Address - Country:US
Mailing Address - Phone:313-753-1721
Mailing Address - Fax:
Practice Address - Street 1:12075 SORRENTO ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3751
Practice Address - Country:US
Practice Address - Phone:313-753-1721
Practice Address - Fax:313-753-1721
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist