Healthcare Provider Details

I. General information

NPI: 1922779743
Provider Name (Legal Business Name): SHANETTA PARKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 56TH ST
BROOKLYN NY
11219-4616
US

IV. Provider business mailing address

93 ARLO RD APT 1B
STATEN ISLAND NY
10301-3889
US

V. Phone/Fax

Practice location:
  • Phone: 347-481-1451
  • Fax:
Mailing address:
  • Phone: 347-481-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number849280-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: