Provider Demographics
NPI:1780367623
Name:SHAKYA, SUMINA
Entity type:Individual
Prefix:
First Name:SUMINA
Middle Name:
Last Name:SHAKYA
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 1:55 TOZER RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5515
Mailing Address - Country:US
Mailing Address - Phone:978-969-2894
Mailing Address - Fax:978-969-2637
Practice Address - Street 1:1216 MANN DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5512
Practice Address - Country:US
Practice Address - Phone:980-262-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0193701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical