Healthcare Provider Details

I. General information

NPI: 1700790029
Provider Name (Legal Business Name): SHANTWAN PARCHMON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 DECATUR ST
BROOKLYN NY
11233-1507
US

IV. Provider business mailing address

12611 RIVER BIRCH DR
RIVERVIEW FL
33569-8224
US

V. Phone/Fax

Practice location:
  • Phone: 813-220-9050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number361066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: