Healthcare Provider Details

I. General information

NPI: 1619898236
Provider Name (Legal Business Name): SHANTIERRA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 W RAWSON AVE STE 132
OAK CREEK WI
53154-8422
US

IV. Provider business mailing address

3436 S 18TH ST
MILWAUKEE WI
53215-4910
US

V. Phone/Fax

Practice location:
  • Phone: 414-722-2735
  • Fax:
Mailing address:
  • Phone: 414-722-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: