Healthcare Provider Details

I. General information

NPI: 1700743036
Provider Name (Legal Business Name): SHANICE JUNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POMPTON RD
WAYNE NJ
07470-2103
US

IV. Provider business mailing address

300 POMPTON RD
WAYNE NJ
07470-2103
US

V. Phone/Fax

Practice location:
  • Phone: 908-409-3306
  • Fax:
Mailing address:
  • Phone: 908-409-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15498300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: