Provider Demographics
NPI:1144897257
Name:SHEAKALEE, ROBERT NORMAN (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:NORMAN
Last Name:SHEAKALEE
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3124
Mailing Address - Country:US
Mailing Address - Phone:559-307-0950
Mailing Address - Fax:661-209-3076
Practice Address - Street 1:1549 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3124
Practice Address - Country:US
Practice Address - Phone:559-307-0950
Practice Address - Fax:661-209-3076
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107201446374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide