Provider Demographics
NPI:1134945694
Name:SHACKELFORD, ERICA LATOYA
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LATOYA
Last Name:SHACKELFORD
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 1:166 GEARY ST FL 15
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5631
Mailing Address - Country:US
Mailing Address - Phone:305-916-0946
Mailing Address - Fax:
Practice Address - Street 1:166 GEARY ST FL 15
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5631
Practice Address - Country:US
Practice Address - Phone:305-916-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier