Provider Demographics
NPI:1659666444
Name:BAKER, SHUKAIRO M (APRN, PMHNP-BC, LCSW)
Entity type:Individual
Prefix:
First Name:SHUKAIRO
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC, LCSW
Other - Prefix:
Other - First Name:SHUKAIRO
Other - Middle Name:MACK
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 W 3RD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4368
Mailing Address - Country:US
Mailing Address - Phone:704-215-5249
Mailing Address - Fax:659-223-0837
Practice Address - Street 1:116 W 3RD AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4368
Practice Address - Country:US
Practice Address - Phone:704-215-5249
Practice Address - Fax:659-223-0837
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008389101YA0400X, 1041C0700X
SC110941041C0700X
SC268707163W00000X
UT13998789-4405363LP0808X
NC5020242363LP0808X
UT13998789-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ554550281OtherPTAN
NC1659666444Medicaid
SCSW1253Medicaid