Healthcare Provider Details

I. General information

NPI: 1609516913
Provider Name (Legal Business Name): SHANELLE MASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WASHINGTON ST
HOBOKEN NJ
07030-4907
US

IV. Provider business mailing address

301 E MAIN ST
BAY SHORE NY
11706-8408
US

V. Phone/Fax

Practice location:
  • Phone: 516-761-0923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: