Healthcare Provider Details

I. General information

NPI: 1831932789
Provider Name (Legal Business Name): SHERENE ANN-MARIE ALLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21104 39TH AVE
BAYSIDE NY
11361-1968
US

IV. Provider business mailing address

21104 39TH AVE
BAYSIDE NY
11361-1968
US

V. Phone/Fax

Practice location:
  • Phone: 954-292-2609
  • Fax: 718-978-0032
Mailing address:
  • Phone: 954-292-2609
  • Fax: 718-978-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number737885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: