MEDICARE: MRS. SHEENA BERGANTINOS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	779680	NY

General Provider Information

NPI Number	:	1518798917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEENA BERGANTINOS RN

Provider Business Mailing Address
First Line	:	9 JACKSON PL
Second Line	:
City	:	MOONACHIE
State	:	NJ
Zip	:	07074-1216
Country	:	US
Telephone Number	:	201-450-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 JACKSON PL
Second Line	:
City	:	MOONACHIE
State	:	NJ
Zip	:	07074-1216
Country	:	US
Telephone Number	:	201-450-5447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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