Healthcare Provider Details

I. General information

NPI: 1134945694
Provider Name (Legal Business Name): MISS ERICA LATOYA SHACKELFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 GEARY ST FL 15
SAN FRANCISCO CA
94108-5631
US

IV. Provider business mailing address

166 GEARY ST FL 15
SAN FRANCISCO CA
94108-5631
US

V. Phone/Fax

Practice location:
  • Phone: 305-916-0946
  • Fax:
Mailing address:
  • Phone: 305-916-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: