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NPI Code Detail

MEDICARE: SHEKENA R KING

MEDICARE: SHEKENA R KING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1144794777
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEKENA R KING
Provider Business Mailing Address
First Line : 1749 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10453-8241
Country : US
Telephone Number : 646-342-0531
Fax Number :
Provider Business Practice Location Address
First Line : 529 COURTLANDT AVE
Second Line :
City : BRONX
State : NY
Zip : 10451-5007
Country : US
Telephone Number : 718-993-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2019
Last Update Date : 01/16/2019

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Directions to “ SHEKENA R KING ” Practice Location

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