Provider Demographics
NPI:1275005027
Name:SPEIGHT, SHANIQUE YEVETTE (LPN)
Entity Type:Individual
Prefix:
First Name:SHANIQUE
Middle Name:YEVETTE
Last Name:SPEIGHT
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 1:751 BRIGGS HWY
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-5501
Mailing Address - Country:US
Mailing Address - Phone:718-206-1990
Mailing Address - Fax:
Practice Address - Street 1:767 CAPE RD
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-5710
Practice Address - Country:US
Practice Address - Phone:718-206-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse