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NPI Code Detail

MEDICARE: MS. SHANTEL SHERYL JOHNSON SOCIAL WORKER

MEDICARE: MS. SHANTEL SHERYL JOHNSON SOCIAL WORKER
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
1104100000XSocial Worker091240NY

General Provider Information

NPI Number : 1568989226
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANTEL SHERYL JOHNSON SOCIAL WORKER
Provider Business Mailing Address
First Line : 14215 129TH AVE
Second Line :
City : JAMAICA
State : NY
Zip : 11436-1720
Country : US
Telephone Number : 917-903-8526
Fax Number :
Provider Business Practice Location Address
First Line : 6603 BEACH CHANNEL DR
Second Line :
City : ARVERNE
State : NY
Zip : 11692-1433
Country : US
Telephone Number : 718-471-8671
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2017
Last Update Date : 08/24/2017

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