Provider Demographics
NPI:1790098275
Name:SHALITA, SHAKILAH M (NP)
Entity Type:Individual
Prefix:
First Name:SHAKILAH
Middle Name:M
Last Name:SHALITA
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:R7
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-2212
Mailing Address - Fax:612-904-4348
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:R7
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2212
Practice Address - Fax:612-904-4348
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR145546-3363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology