Provider Demographics
NPI:1053000828
Name:HANKINS, SHAWNTELLE
Entity type:Individual
Prefix:
First Name:SHAWNTELLE
Middle Name:
Last Name:HANKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ANDREWS ROAD
Mailing Address - Street 2:SUITE 5A-30
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311
Mailing Address - Country:US
Mailing Address - Phone:614-943-3323
Mailing Address - Fax:
Practice Address - Street 1:5843 RAMSEY STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311
Practice Address - Country:US
Practice Address - Phone:888-348-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66436224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist