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General NPI Number Information
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NPI Number | 1487366993
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Entity Type | Individual
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Provider Name | SHAWN JAMEL WRIGHT FNP- BC
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Gender | Male
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 11342 199TH ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2507
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Country | US
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Telephone | 305-332-8947
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Fax |
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Provider Business Mailing Address
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Address Line | 1072 E 81ST ST
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City | BROOKLYN
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State | NY
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Zip | 11236-4222
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Country | US
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Telephone | 718-473-7169
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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 | 350934
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License Number State | NY
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