Healthcare Provider Details

I. General information

NPI: 1043611924
Provider Name (Legal Business Name): SHAIINA MARSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WHALEY ST
FREEPORT NY
11520-4223
US

IV. Provider business mailing address

206 WHALEY ST
FREEPORT NY
11520-4223
US

V. Phone/Fax

Practice location:
  • Phone: 516-304-4714
  • Fax:
Mailing address:
  • Phone: 516-304-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number683949-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number683949-1
License Number StateNY

VIII. Authorized Official

Name: MS. SHAIINA KHITANYA MARSTON
Title or Position: REGISTERED NURSE
Credential:
Phone: 516-304-4714