Provider Demographics
NPI:1972291896
Name:SHANKLIN, LATEYA
Entity Type:Individual
Prefix:
First Name:LATEYA
Middle Name:
Last Name:SHANKLIN
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 1:1440 ROCKSIDE RD STE 216
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2749
Mailing Address - Country:US
Mailing Address - Phone:216-777-6062
Mailing Address - Fax:216-777-6064
Practice Address - Street 1:1440 ROCKSIDE RD STE 216
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2749
Practice Address - Country:US
Practice Address - Phone:216-777-6062
Practice Address - Fax:216-777-6064
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator