Healthcare Provider Details

I. General information

NPI: 1114844008
Provider Name (Legal Business Name): LATONIA SHAKIRA EDWARDS APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 MAIN ST UNIT 447
NEW ROCHELLE NY
10801-7101
US

IV. Provider business mailing address

669 MAIN ST UNIT 447
NEW ROCHELLE NY
10801-7101
US

V. Phone/Fax

Practice location:
  • Phone: 347-888-5704
  • Fax:
Mailing address:
  • Phone: 347-888-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17742
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: