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NPI Code Detail

MEDICARE: SHUKAIRO M BAKER APRN, PMHNP-BC, LCSW

MEDICARE: SHUKAIRO M BAKER APRN, PMHNP-BC, LCSW
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0024194469VA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner890763NV
3363LP0808XPsychiatric/Mental Health Nurse Practitioner317733AZ
4363LP0808XPsychiatric/Mental Health Nurse PractitionerAP70007419WA
51041C0700XClinical Social Worker11094SC
6363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11044782FL
7363LP0808XPsychiatric/Mental Health Nurse Practitioner13998789-4405UT
8363LP0808XPsychiatric/Mental Health Nurse Practitioner13998789-8900UT
91041C0700XClinical Social WorkerC008389NC
10363LP0808XPsychiatric/Mental Health Nurse PractitionerC-RXN.0102908-C-NPCO
11101YA0400XAddiction (Substance Use Disorder) CounselorC008389NC
12363LP0808XPsychiatric/Mental Health Nurse Practitioner31253ASC
13363LP0808XPsychiatric/Mental Health Nurse Practitioner5020242NC
14363LP0808XPsychiatric/Mental Health Nurse Practitioner254611MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q554550281OTHERSCPTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659666444
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHUKAIRO M BAKER APRN, PMHNP-BC, LCSW
Provider Business Mailing Address
First Line : 455 LAKESHORE PKWY
Second Line :
City : ROCK HILL
State : SC
Zip : 29730-4205
Country : US
Telephone Number :
Fax Number : 877-658-8669
Provider Business Practice Location Address
First Line : 455 LAKESHORE PKWY
Second Line :
City : ROCK HILL
State : SC
Zip : 29730-4205
Country : US
Telephone Number : 803-909-6363
Fax Number : 803-909-6390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2011
Last Update Date : 04/14/2026

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