Healthcare Provider Details

I. General information

NPI: 1972411726
Provider Name (Legal Business Name): SHANICE ARIELLE GROSS DNP, NP, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 PARK AVE
HUNTINGTON NY
11743-3900
US

IV. Provider business mailing address

1125 VAN BUREN PL
BALDWIN NY
11510-4810
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-1640
  • Fax:
Mailing address:
  • Phone: 516-672-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: