Provider Demographics
NPI:1205234705
Name:MAST, SHEKINAH (AUD)
Entity type:Individual
Prefix:
First Name:SHEKINAH
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MIDDLEFORD RD
Mailing Address - Street 2:STE 4
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3650
Mailing Address - Country:US
Mailing Address - Phone:302-629-8078
Mailing Address - Fax:302-628-9055
Practice Address - Street 1:808 MIDDLEFORD RD
Practice Address - Street 2:STE 4
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3650
Practice Address - Country:US
Practice Address - Phone:302-629-8078
Practice Address - Fax:302-628-9055
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO2-0000217231H00000X
MD01328231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH621Medicare PIN