Healthcare Provider Details

I. General information

NPI: 1114731049
Provider Name (Legal Business Name): SHEENA DAFFIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GARRISON DR
SPRING VALLEY NY
10977-6070
US

IV. Provider business mailing address

21 GARRISON DR
SPRING VALLEY NY
10977-6070
US

V. Phone/Fax

Practice location:
  • Phone: 646-772-6225
  • Fax:
Mailing address:
  • Phone: 646-772-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: