Provider Demographics
NPI:1588491930
Name:FLUKER, SHANTESHA SOLONIA-LUVLONDA (MPSS)
Entity type:Individual
Prefix:MISS
First Name:SHANTESHA
Middle Name:SOLONIA-LUVLONDA
Last Name:FLUKER
Suffix:
Gender:F
Credentials:MPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ESTUDILLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4611
Mailing Address - Country:US
Mailing Address - Phone:925-897-8724
Mailing Address - Fax:
Practice Address - Street 1:545 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4611
Practice Address - Country:US
Practice Address - Phone:925-897-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-SXFVYD172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker