Provider Demographics
NPI:1306492665
Name:BANKS, SHAHIRMARIASHA P
Entity type:Individual
Prefix:
First Name:SHAHIRMARIASHA
Middle Name:P
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MEADOWWICK DRIVE
Mailing Address - Street 2:APT B
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056
Mailing Address - Country:US
Mailing Address - Phone:601-613-4943
Mailing Address - Fax:
Practice Address - Street 1:509 SPRINGRIDGE RD STE I
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5611
Practice Address - Country:US
Practice Address - Phone:601-488-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS246Y00000X
246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty