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NPI Code Detail

MEDICARE: SHAKEDRA KENNEDY

MEDICARE: SHAKEDRA KENNEDY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396313318
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAKEDRA KENNEDY
Provider Business Mailing Address
First Line : PO BOX 399318
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94139-9318
Country : US
Telephone Number : 866-523-4268
Fax Number :
Provider Business Practice Location Address
First Line : 1215 HIGHTOWER TRL
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30350-6244
Country : US
Telephone Number : 866-523-4268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2021
Last Update Date : 06/15/2021

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Directions to “ SHAKEDRA KENNEDY ” Practice Location

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