Provider Demographics
NPI:1154906717
Name:SHANKOL, RESHID TAHIR
Entity type:Individual
Prefix:
First Name:RESHID
Middle Name:TAHIR
Last Name:SHANKOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BIRCH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7415
Mailing Address - Country:US
Mailing Address - Phone:207-440-6947
Mailing Address - Fax:
Practice Address - Street 1:57 BIRCH ST STE 204
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7415
Practice Address - Country:US
Practice Address - Phone:207-440-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker