Provider Demographics
NPI:1992173546
Name:WALKER, SHATARA (MST)
Entity type:Individual
Prefix:
First Name:SHATARA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 BENEDICT RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9311
Mailing Address - Country:US
Mailing Address - Phone:607-222-6161
Mailing Address - Fax:
Practice Address - Street 1:6860 BENEDICT RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9311
Practice Address - Country:US
Practice Address - Phone:607-222-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY934246151252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency