Provider Demographics
NPI:1801637251
Name:BANKSTON, SHANIEKA
Entity type:Individual
Prefix:
First Name:SHANIEKA
Middle Name:
Last Name:BANKSTON
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 1:2698 GREEN HL
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-7857
Mailing Address - Country:US
Mailing Address - Phone:330-281-0903
Mailing Address - Fax:
Practice Address - Street 1:2698 GREEN HL
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-7857
Practice Address - Country:US
Practice Address - Phone:330-281-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty