Provider Demographics
NPI:1003663154
Name:CANTY, SHAKERA (LPN)
Entity type:Individual
Prefix:
First Name:SHAKERA
Middle Name:
Last Name:CANTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SPRING ST APT 115
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-1868
Mailing Address - Country:US
Mailing Address - Phone:864-399-4415
Mailing Address - Fax:
Practice Address - Street 1:218 SPRING ST APT 115
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-1868
Practice Address - Country:US
Practice Address - Phone:864-399-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC62-2180901OtherGOVERMENT