Provider Demographics
NPI:1740507185
Name:SHAKKED, RACHEL (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SHAKKED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:267-339-3543
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:600 EVERGREEN DR STE 201
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1053
Practice Address - Country:US
Practice Address - Phone:800-321-9999
Practice Address - Fax:267-339-6763
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10134000207XX0004X
PAMD458546207X00000X, 207XX0004X
NY274950207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery