Healthcare Provider Details

I. General information

NPI: 1174122865
Provider Name (Legal Business Name): SHAKEVA BROWN NNAJI PHELEBTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 HAMMERSLEY AVE
BRONX NY
10469-3024
US

IV. Provider business mailing address

1469 HAMMERSLEY AVE
BRONX NY
10469-3024
US

V. Phone/Fax

Practice location:
  • Phone: 914-563-7372
  • Fax:
Mailing address:
  • Phone: 914-563-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: