Provider Demographics
NPI:1932095767
Name:MATOS, SHAMIKA LEAE
Entity type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:LEAE
Last Name:MATOS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ALCOTT PL APT 19H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4320
Mailing Address - Country:US
Mailing Address - Phone:646-671-8825
Mailing Address - Fax:
Practice Address - Street 1:140 ALCOTT PL APT 19H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4320
Practice Address - Country:US
Practice Address - Phone:646-671-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula