Provider Demographics
NPI:1801636378
Name:AUTRY, SHAKIRA TATJANA
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:TATJANA
Last Name:AUTRY
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 1:2815 W AVENUE K12 APT 170
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1141
Mailing Address - Country:US
Mailing Address - Phone:661-779-3154
Mailing Address - Fax:
Practice Address - Street 1:348 E AVENUE K4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4505
Practice Address - Country:US
Practice Address - Phone:661-310-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator