Provider Information for 1609322437
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SHAAKIRA GILLETTE M.SS
Sex: Female
NPI: 1609322437
Last Updated: 2016-08-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1609322437 | ||||||||
| Enumeration Date | 2016-08-31 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8319 LYNNEWOOD RD PHILADELPHIA, PA 19150-3202 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 2514 N. BROAD ST PHILADELPHIA, PA 19132 United States Phone: 215-456-2685 | Fax: | ||||||||
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