Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1457029092 |
---|---|
Provider Name | Sheneka Clark |
First Address | Brooklyn, NY 11217-1160 |
Second Address | Brooklyn, NY 11217-1160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |