Provider Demographics
NPI:1811691314
Name:MERCADO, SHAMEKA
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:
Last Name:MERCADO
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 1:453 BEACH 40TH ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1366
Mailing Address - Country:US
Mailing Address - Phone:347-829-0915
Mailing Address - Fax:718-868-3050
Practice Address - Street 1:453 BEACH 40TH ST APT 4F
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1366
Practice Address - Country:US
Practice Address - Phone:347-829-0915
Practice Address - Fax:718-868-3050
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No305S00000XManaged Care OrganizationsPoint of Service