Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | SP007721 | PA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 38289 | WV |
NPI | 1013015577 |
---|---|
Provider Name | Sherica A. Shapaka |
First Address | Daytona Beach, FL 32117-5167 |
Second Address | Morgantown, WV 26506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 23/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q30719 | (02) |