Provider Demographics
NPI:1235619446
Name:SHINN, CHANEL MONIQUE
Entity Type:Individual
Prefix:MS
First Name:CHANEL
Middle Name:MONIQUE
Last Name:SHINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BEAR ST
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3803
Mailing Address - Country:US
Mailing Address - Phone:631-561-7212
Mailing Address - Fax:
Practice Address - Street 1:15 BEAR ST
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3803
Practice Address - Country:US
Practice Address - Phone:631-561-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332395164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse