Provider Demographics
NPI:1265234405
Name:MUKANDEKEZI, SHAKIRAH
Entity type:Individual
Prefix:
First Name:SHAKIRAH
Middle Name:
Last Name:MUKANDEKEZI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHAKIRAH
Other - Middle Name:MUKANDEKEZI
Other - Last Name:KUTEESA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 COMEE ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2306
Mailing Address - Country:US
Mailing Address - Phone:781-330-6783
Mailing Address - Fax:
Practice Address - Street 1:4 COMEE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2306
Practice Address - Country:US
Practice Address - Phone:781-330-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2353628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse