Provider Demographics
NPI:1841764008
Name:STREETE, SHAKAY
Entity Type:Individual
Prefix:
First Name:SHAKAY
Middle Name:
Last Name:STREETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAKAY
Other - Middle Name:
Other - Last Name:STREETE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:11602 MEXICO ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3035
Mailing Address - Country:US
Mailing Address - Phone:347-898-4915
Mailing Address - Fax:
Practice Address - Street 1:11602 MEXICO ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3035
Practice Address - Country:US
Practice Address - Phone:347-898-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse