Provider Demographics
NPI:1932541836
Name:SHANKS, SKY PATRICE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SKY
Middle Name:PATRICE
Last Name:SHANKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:935 TRANCAS ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2932
Mailing Address - Country:US
Mailing Address - Phone:707-259-0766
Mailing Address - Fax:707-259-0183
Practice Address - Street 1:935 TRANCAS ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2932
Practice Address - Country:US
Practice Address - Phone:707-259-0766
Practice Address - Fax:707-259-0183
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5106213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA 129883Medicare PIN
CACA130533Medicare PIN
CACA129884Medicare PIN