Provider Demographics
NPI:1932673951
Name:SHAKUR, SHAKLEEN A (CNP)
Entity Type:Individual
Prefix:
First Name:SHAKLEEN
Middle Name:A
Last Name:SHAKUR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3928
Mailing Address - Country:US
Mailing Address - Phone:612-208-0985
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST # E4300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-3110
Practice Address - Fax:612-863-3158
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6868363LP0808X, 363LF0000X, 363L00000X
MN1999330163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse