Provider Demographics
NPI:1093022949
Name:POORAN, SHANTA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANTA
Middle Name:
Last Name:POORAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4204
Mailing Address - Country:US
Mailing Address - Phone:516-783-5299
Mailing Address - Fax:
Practice Address - Street 1:875 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3038
Practice Address - Country:US
Practice Address - Phone:516-572-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271118-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse