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General NPI Number Information
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NPI Number | 1295501013
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Entity Type | Individual
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Provider Name | SHAUNIQUE DYER
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Gender | Female
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 70 ADAMS ST
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City | NEWARK
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State | NJ
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Zip | 07105-2354
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Country | US
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Telephone | 973-465-7707
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Fax |
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Provider Business Mailing Address
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Address Line | 32 ARNOLD DR
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-2528
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Country | US
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Telephone | 646-207-0020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ14960500
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License Number State | NJ
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