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NPI Code Detail

MEDICARE: SHAKISHA CARTER

MEDICARE: SHAKISHA CARTER
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
1225400000XRehabilitation Practitioner
2101Y00000XCounselor
3373H00000XDay Training/Habilitation Specialist
4172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1457911687
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAKISHA CARTER
Provider Business Mailing Address
First Line : 400 ESTUDILLO AVE STE 100
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-4962
Country : US
Telephone Number : 510-924-0548
Fax Number :
Provider Business Practice Location Address
First Line : 400 ESTUDILLO AVE STE 100
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-4962
Country : US
Telephone Number : 510-924-0548
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2019
Last Update Date : 12/29/2025

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Directions to “ SHAKISHA CARTER ” Practice Location

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