Healthcare Provider Details

I. General information

NPI: 1992981534
Provider Name (Legal Business Name): SHAKOYIA S ANTOINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E SHAW AVE STE 210
FRESNO CA
93710-7621
US

IV. Provider business mailing address

732 WASHINGTON AVE
MADERA CA
93638-3458
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax: 559-221-8101
Mailing address:
  • Phone: 559-824-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: