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General NPI Number Information
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NPI Number | 1467797753
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Entity Type | Individual
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Provider Name | JENNY SHMUSHKEVICH CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 355 BARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1699
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Country | US
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Telephone | 718-818-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 100 ROUTE 59 SUITE 105
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City | SUFFERN
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State | NY
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Zip | 10901-4927
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Country | US
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Telephone | 845-357-5775
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Fax | 845-357-5777
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR14071400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 581083
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ00422600
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License Number State | NJ
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