MEDICARE: DR. SHANA LABORDE M.D.

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	208D00000X	General Practice Physician	P01015	NY

General Provider Information

NPI Number	:	1962856328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANA LABORDE M.D.

Provider Business Mailing Address
First Line	:	3198 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1000
Country	:	US
Telephone Number	:	718-618-0401
Fax Number	:	718-795-4394

Provider Business Practice Location Address
First Line	:	1265 FULTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3401
Country	:	US
Telephone Number	:	718-579-7000
Fax Number	:	718-299-6797

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	05/04/2017

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