Provider Demographics
NPI:1902696669
Name:BURT, SHEKINAH ANN
Entity type:Individual
Prefix:MS
First Name:SHEKINAH
Middle Name:ANN
Last Name:BURT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 LEE ROAD 36
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-9025
Mailing Address - Country:US
Mailing Address - Phone:256-443-2158
Mailing Address - Fax:
Practice Address - Street 1:1905 LEE ROAD 36
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-9025
Practice Address - Country:US
Practice Address - Phone:256-443-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health