Provider Demographics
NPI:1881151025
Name:SHUSTER, ANNIKA MYCHELLE
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:MYCHELLE
Last Name:SHUSTER
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 1:731 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3942
Mailing Address - Country:US
Mailing Address - Phone:330-507-3413
Mailing Address - Fax:
Practice Address - Street 1:731 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3942
Practice Address - Country:US
Practice Address - Phone:330-507-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer