Healthcare Provider Details

I. General information

NPI: 1609393248
Provider Name (Legal Business Name): SHAUNTE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: N/A N/A N/A S. JOHNSON, RN, BSN

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 MAIN ST # 1050
NEW ROCHELLE NY
10801-7101
US

IV. Provider business mailing address

669 MAIN ST # 1050
NEW ROCHELLE NY
10801-7101
US

V. Phone/Fax

Practice location:
  • Phone: 347-978-4577
  • Fax: 347-449-6550
Mailing address:
  • Phone: 347-978-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number889569
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR25020600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number889569
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5250969
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number329529-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: