MEDICARE: KERONA SHELLIAN BURKE-JAMES

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	183700000X	Pharmacy Technician	30247490	NY

General Provider Information

NPI Number	:	1720866833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERONA SHELLIAN BURKE-JAMES

Provider Business Mailing Address
First Line	:	3428 BRUNER AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2667
Country	:	US
Telephone Number	:	917-969-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	3428 BRUNER AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2667
Country	:	US
Telephone Number	:	917-969-7561
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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