Provider Demographics
NPI:1255830741
Name:LEVINE, SHAKIB
Entity type:Individual
Prefix:
First Name:SHAKIB
Middle Name:
Last Name:LEVINE
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 1:504 MACON ST S
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-6028
Mailing Address - Country:US
Mailing Address - Phone:919-744-0360
Mailing Address - Fax:
Practice Address - Street 1:161 S WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3420
Practice Address - Country:US
Practice Address - Phone:919-744-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist