Provider Demographics
NPI:1801620141
Name:HICKS, SHATEEA MARTHA
Entity type:Individual
Prefix:MISS
First Name:SHATEEA
Middle Name:MARTHA
Last Name:HICKS
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 1:2920 W 21ST ST APT 9Q
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2967
Mailing Address - Country:US
Mailing Address - Phone:929-392-3008
Mailing Address - Fax:
Practice Address - Street 1:2920 W 21ST ST APT 9Q
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2967
Practice Address - Country:US
Practice Address - Phone:929-392-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342941-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse