Provider Demographics
NPI:1821728213
Name:BASTFIELD, SHAKICA N
Entity Type:Individual
Prefix:
First Name:SHAKICA
Middle Name:N
Last Name:BASTFIELD
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 1:5513 MONROE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5503
Mailing Address - Country:US
Mailing Address - Phone:980-273-2726
Mailing Address - Fax:
Practice Address - Street 1:5513 MONROE RD STE 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5503
Practice Address - Country:US
Practice Address - Phone:980-273-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC546940376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide