Provider Demographics
NPI:1255897732
Name:ALLEN, SHEKIVA LUCILLE
Entity type:Individual
Prefix:
First Name:SHEKIVA
Middle Name:LUCILLE
Last Name:ALLEN
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 1:2101 KINGSLEY DR APT 19101
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4132
Mailing Address - Country:US
Mailing Address - Phone:281-979-1584
Mailing Address - Fax:
Practice Address - Street 1:2101 KINGSLEY DRIVE
Practice Address - Street 2:19101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5356
Practice Address - Country:US
Practice Address - Phone:281-979-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16288111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management