Healthcare Provider Details

I. General information

NPI: 1972273894
Provider Name (Legal Business Name): JONIDA SHESHORI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 REMSEN AVE
ROSLYN NY
11576-2102
US

IV. Provider business mailing address

53 REMSEN AVE
ROSLYN NY
11576-2102
US

V. Phone/Fax

Practice location:
  • Phone: 347-804-6282
  • Fax:
Mailing address:
  • Phone: 347-804-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356831
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number714085-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: