Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 2015-01007 | NC |
N | 207VG0400X | Gynecologist | 2015-01007 | NC |
N | 207VX0000X | Obstetrician | 2015-01007 | NC |
NPI | 1083908644 |
---|---|
Provider Name | Dr. Mena A Shaker |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 29/06/2015 |