Provider Demographics
NPI:1992052765
Name:BURKHALTER, SHAKEYA M (LPN)
Entity type:Individual
Prefix:MS
First Name:SHAKEYA
Middle Name:M
Last Name:BURKHALTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 DORCHESTER ROAD
Mailing Address - Street 2:APT 4I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6081
Mailing Address - Country:US
Mailing Address - Phone:917-974-9773
Mailing Address - Fax:
Practice Address - Street 1:2116 DORCHESTER RD
Practice Address - Street 2:APT 4I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6080
Practice Address - Country:US
Practice Address - Phone:917-974-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309768-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse