Healthcare Provider Details

I. General information

NPI: 1518541762
Provider Name (Legal Business Name): NIQUANA SHADEL WHITE PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 RALPH AVE STE C
BROOKLYN NY
11234-5300
US

IV. Provider business mailing address

160 BLEECKER ST APT 2L
BROOKLYN NY
11221-3924
US

V. Phone/Fax

Practice location:
  • Phone: 302-563-1081
  • Fax:
Mailing address:
  • Phone: 302-563-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number8003210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: