Provider Demographics
NPI:1669120689
Name:EBANKS, SHAKIRA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:EBANKS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 WINTER HAZEL RD APT 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7739
Mailing Address - Country:US
Mailing Address - Phone:281-425-5116
Mailing Address - Fax:
Practice Address - Street 1:768 TYVOLA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3508
Practice Address - Country:US
Practice Address - Phone:704-240-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH7420332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies