Healthcare Provider Details

I. General information

NPI: 1952904732
Provider Name (Legal Business Name): SHINNY CHRISTIAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BAY ST
STATEN ISLAND NY
10301-2510
US

IV. Provider business mailing address

57 BAY ST
STATEN ISLAND NY
10301-2510
US

V. Phone/Fax

Practice location:
  • Phone: 855-681-8700
  • Fax:
Mailing address:
  • Phone: 844-400-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: