Provider Demographics
NPI:1366213498
Name:SHANK, SHAWNAY TYKEIA (BT)
Entity type:Individual
Prefix:
First Name:SHAWNAY
Middle Name:TYKEIA
Last Name:SHANK
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 LILBURN SCHOOL RD NW APT C1
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4931
Mailing Address - Country:US
Mailing Address - Phone:856-577-2971
Mailing Address - Fax:
Practice Address - Street 1:3070 BUSINESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1428
Practice Address - Country:US
Practice Address - Phone:770-884-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst