Provider Demographics
NPI:1700311552
Name:BILLINGS, SHAKELL
Entity Type:Individual
Prefix:
First Name:SHAKELL
Middle Name:
Last Name:BILLINGS
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 1:13455 176TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4549
Mailing Address - Country:US
Mailing Address - Phone:347-869-6673
Mailing Address - Fax:
Practice Address - Street 1:134-55176ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:BASEMENT
Practice Address - Zip Code:11434
Practice Address - Country:UM
Practice Address - Phone:347-869-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343419070513E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY184916877Medicaid