Provider Demographics
NPI:1932486974
Name:RAIKES, SHELLY MONIQUE (BS)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:MONIQUE
Last Name:RAIKES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 POLARIS CV
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5920
Mailing Address - Country:US
Mailing Address - Phone:561-304-2744
Mailing Address - Fax:561-712-8070
Practice Address - Street 1:5026 POLARIS CV
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5920
Practice Address - Country:US
Practice Address - Phone:561-304-2744
Practice Address - Fax:561-712-8070
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker