Healthcare Provider Details

I. General information

NPI: 1700391125
Provider Name (Legal Business Name): SHANIQUE TERRELONGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 I U WILLETS RD
ALBERTSON NY
11507-1516
US

IV. Provider business mailing address

181 HOLLAND AVE
ELMONT NY
11003-1630
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-1650
  • Fax: 516-465-3742
Mailing address:
  • Phone: 347-545-8433
  • Fax: 516-465-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number736150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: