Healthcare Provider Details

I. General information

NPI: 1700709912
Provider Name (Legal Business Name): SHANIYA AMARI CADOGAN MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 AVENUE J FL 2
BROOKLYN NY
11230-3605
US

IV. Provider business mailing address

14 STACY DR
PORT JEFFERSON STATION NY
11776-3157
US

V. Phone/Fax

Practice location:
  • Phone: 718-814-7200
  • Fax:
Mailing address:
  • Phone: 718-814-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2079566261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: