Healthcare Provider Details

I. General information

NPI: 1689998916
Provider Name (Legal Business Name): SHANEEKWA SHAUNTE PERKINS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI PERKINS DPM

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18056 WIKA RD STE C
APPLE VALLEY CA
92307-2194
US

IV. Provider business mailing address

10 WEST ST UNIT 7
WEST HATFIELD MA
01088-9554
US

V. Phone/Fax

Practice location:
  • Phone: 760-628-2021
  • Fax: 760-867-3302
Mailing address:
  • Phone: 413-397-8900
  • Fax: 413-247-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD2394
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberLL9564
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number6050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: