Healthcare Provider Details

I. General information

NPI: 1053000828
Provider Name (Legal Business Name): SHAWNTELLE HANKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5843 RAMSEY STREET
FAYETTEVILLE NC
28311
US

IV. Provider business mailing address

150 ANDREWS ROAD SUITE 5A-30
FAYETTEVILLE NC
28311
US

V. Phone/Fax

Practice location:
  • Phone: 888-348-1100
  • Fax:
Mailing address:
  • Phone: 614-943-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number66436
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: